Secretary of Health
2282565988627108472-16705447260872-23747598384117-25045817260872-2374759ILOCOS TRAINING AND REGIO8536517-3209431NAL MEDICAL CENTERCITIZEN’S CHARTER2020 (2nd Edition)Mandate:Ilocos Training and Regional Medical Center or ITRMC is a DOH retained, 300-bed capacity, tertiary hospital located at the heart of La Union. It has been established since 1945 by the virtue of Republic Act No. 8411 with the main goal of providing quality healthcare for the Filipino people and to all those who need medical attention and treatment through delivery of specialized medical service, promotion of relevant research projects through accredited training program, sound implementation of preventive health program, efficient utilization and maintenance of resources and dynamic and continuous staff development.ITRMC is also affiliated with more than 20 Medical and Paramedical schools for Post Graduate training/ rotations in the Clinical Departments and Internship for Medical Technologists, Physical Therapists, Nurses, Midwives and Caregivers.Vision:A people-centered Multi-specialty Regional Medical Center delivering quality health services and training in the Ilocos Region by 2022Mission:Provide safe, equitable, accessible, responsive, and evidence-based health services for all through a competent work force, state-of-the-art facilities, and community engagement.Service Pledge:Dedicated to provide optimum quality care under the leadership of the Department of Health and in compliance with the statutory and regulatory requirements and we shall continuously improve our Quality Management System to the satisfaction of all mitted in providing integrated quality training in compliance with standardized training programs and we shall continuously improve to the satisfaction of all stakeholders.LIST OF SERVICESExternal ServicesAcquisition of Bidding Documents23Application for Medical Social Services39Availing of Dental Services41Blood Donation (Voluntary)43Consultation for Clients using E-Konsulta53Consultation for Clients with OPD Online Appointment45Consultation for Referred Canceror Hema Out-Patient51Collection/ Receiving Of Specimens (Body Tissues, Body Fluids) For Processing, Storage, And Tesing58COVID 19 (RT-PCR) Testing67Disbursement to External Creditors7Dispensing of Medicines for Out Patient(PhilHealth Patient, Medical Assistance)69Discharge from Oncology Unit After Out Patient Chemotherapy Infusion105Dispensing of Medicines for Out Patient(Cash)91Emergency Room Consultation95Enrolment to Point of Service Program 93Hemodialysis Treatment194Issuance of Certificate of Remittance16Issuance of Notice of Award25Issuance of Official Receipt of Collection of Hospital Fees and Charges9Issuance of Statement of Account for Non PHIC Patient11Issuance of Statement of Account for PHIC Patient13Malasakit Center110OPD Physical Therapy106Out Patient Cancer and Hematology Consultation113Out Patient Chemotherapy Infusion111Out Patient CT-Scan133Out Patient Dental Radiography116Out Patient Magnetic Resonance Imaging (MRI)118Out Patient Ultrasound122Out Patient X-Ray126Processing of Refund (Petty Cash Voucher)15Request for Certified True Copies of Hospital Health Records144Request for Death Certificate (Non-COVID-19)139Request for Death Certificate (COVID-19)141Request for Medical Certificate/Confinement Certificate137Request for Medico Legal Certificate/Violet Ribbon142Receiving and Processing of Applications26Request for Birth Certificate Clearance146Special Case Management Assistance148Vaccination for Follow Up of ABTC Clients149Internal ServicesConduction of Human Resource Training207Disbursement to Internal Creditors19Discharging a Patient from Clinical Areas (COVID 19)197Discharging a Patient from Clinical Areas (Non-COVID-19)196Dispensing of Medicines for In-Patient152Request for Certificate of Availability of Fund (CAF)20Collection, Preparation, Evaluation of the Resultof Customer Satisfaction Survey30In-Patient CT-Scan181In-Patient Dental Radiography183In-Patient Magnetic Resonance Imaging (MRI)185In-Patient Ultrasound189In-Patient X-Ray175Inquiries and other Legal Assistance208 Issuance of Certifications of Employment31Issuance of Newly Sewed Linen32Issuance of Requested Supplies/ Equipment33Legal Adviceon Affidavit to Use Surname of Father (AUSF) with Legal Impediments/ Issues210Newborn Screening for In-Patient174Nursing Office Transaction205Participation to External Human Resource Development Activity211Processing of Documentsin the Office of ChiefAdministrative Officer34Request for Abstract of Bids/ Minutes of Pre-Bid Conference28Receiving of Records for Safe Keeping and Filing37Receiving of Soiled Linen36Finance DivisionFrontline Services1. Disbursement to External CreditorsThe Cash Section is responsible for the releasing of checks to suppliers and creditors in payment of various expenses and obligations.Office or Division:Finance Division – Cash SectionClassification:Simple TransactionType of Transaction:G2C- Government to Client/ G2B-Governemtn to Business/G2G- Government to GovernmentWho may avail:External CreditorsCHECKLIST OF REQUIREMENTSWHERE TO SECURECompany ID (1 original copy)Company of SupplierAuthorization Letter (1 original copy)Company of SupplierOfficial Receipt/Collection Receipt (1original copy)Company of SupplierCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESign in the logbook1. Provides logbook for suppliersNone1 minuteAdministrative Officer ICash SectionPresent authenticity of company ID and authorization of the representative2. Receives and verifies authenticity of presented documents and check for completenessNone1 minuteAdministrative Officer ICash SectionWait for the retrieval of check/LDDAP and disbursement voucher3. Retrieves Check and Disbursement VoucherNone2 minutesAdministrative Officer ICash SectionIssue Official Receipt/Collection Receipt4. Receives Official Receipt and attach to the disbursement voucherNone3 minutesAdministrative Officer ICash SectionSign necessary parts in the disbursement voucher5. Guides client in areas for signatureNone1 minuteAdministrative Officer ICash SectionTotal:None8 minutes2. Issuance of Official Receipt Collection of Hospital Fees and ChargesThe Cash Section is responsible for the collection of payments of patients’ hospital fees and charges and other stakeholders and the issuance of corresponding Official Receipts. The section accepts mode of payments such as (1) Cash, (2) Cashier’s Check, (3) Manager’s Check, (4) Government Check (5) Credit Card (6) Debit Card. If client opted to use credit/debit card, an authorization is needed if client is not the owner of the card. If professional fees are to be paid using credit/debit card a consent form from the doctors to deduct bank charge is needed.Office or Division:Finance Division – Cash SectionClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/ G2B-Governemtn to Business/G2G- Government to GovernmentWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREStatement of Account (1 original copy)Billing and Claims SectionCharge Slip/s (1 original copy)Cost CentersSituantional requirement:MSS Yellow Card/ Senior ID/ PWD ID (1 original copy)Medical Social Service/Municipal OfficeAuthorization for the use of credit/debit card (if not the owner) (1 original copy)Cash SectionCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEGet a queuing number card1. Provides queuing number cardNone1 minuteAdministrative Officer IIICash SectionPresent the computed:a. Statement of Accountb. Charge Slip/s Classified by Medical Social Worker or MSS Yellow Card(*Acceptance of Yellow Cards-8:00am-4:00pmDaily) or Senior Citizen ID/PWD ID2. Receives presented documents and checks for completeness and accuracy of computationNone2 minutesAdministrative Officer IIICash SectionWait for the encoding of particulars in the computera. Out-Patient:Charge Slipsb. In Patient Pay3. Processes encoding of Official ReceiptNone8 minutesAdministrative Officer IIICash SectionTender Payment4 Receives payment from clientSum of the computed charge slip/Statement of Account3 minutesAdministrative Officer IIICash SectionOut-Patient: Receives Official ReceiptIn-Patient: Receives official receipt/s with stamped “OK for Discharge”5. Provides Official Receipt/s to clientNone1 minuteAdministrative Officer IIICash SectionTotal:Sum of the computed Charge slip/Statement of Account15 minutes3. Issuance of Statement of Account (Non-PHIC)This is a process of requesting final or tentative billing statement of patient without PHIC.Office or Division:Finance Division- Billing and Claims SectionClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREFacesheet/Clinical Coversheet (1 original copy)Nurses’ StationRequest Slip (1 original copy)Billing and Claims SectionCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1.Wait for advice from Nurses/Nursing Attendant/Midwife from different wards/units after forwarding the Facesheet/Clinical Cover Sheet to Billing and Claims1. Receives Face sheet with complete diagnosis from ward nurse on duty.1.1 Fill ups turn-around time of receipt, check completeness of attached requirementsNone1 minuteAdministrative Assistant IBilling and Claims Section2. Request for Statement of Account2. Retrieves patient’s ledger card envelope, checks charge slips used and encode additional charges if any.2.1 Prepares and prints billing statement for Non PHIC patientsNone10 minutesAdministrative Assistant IBilling and Claims Section3. Receive the Statement of Account3. Issues Statement of Account to the Ward Nurse on duty/patient’s representativeNote: In case of availment of discount re-compute final bill based on the re-classified/modified payment scheme as approved by Medical Social Welfare Office (Charity) and instruct patient’ watcher/representative for payment to CashierNone5 minutesAdministrative Assistant IBilling and Claims SectionTotal:None16 minutes4. Issuance of Statement of Account (with PHIC)This is a process of requesting final or tentative billing statement of patient with PHIC.Office or Division:Finance Division- Billing and Claims SectionClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREFacesheet/Clinical Coversheet (1original copy)Nurses’ StationCharge Slip (1 original copy)Billing and Claims SectionRequest Form (1 original copy)Billing and Claims SectionOfficial Receipt (1 original copy)Cashier SectionCF4 (computer generated)Attending PhysicianSituational Requirements:Operating Room technique (1 original copy)Laboratory Results (1 original copy)ECG result (1 original copy)X-ray result (1 original copy)Nurse’s StationCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Proceed to the PHIC Portal, present MDR (Member Data Record) or PHIC ID or member/patient for ER - PHIC Portal Staff eligibility check.1. Receives and verifies PhilHealth elegibility.1.1 Fill ups turn-around time of receipt, check completeness of attached requirementsNone10 minute- PBEF GenerationAdministrative Assistant IBilling and Claims Section2. 2. Check details on PBEF if there are discrepancies on the information provided (Name of Member, Name of Patient, Birthdate and date of admission).2.1 Affix signature over printed name on the PBEF. Forward to Ward Nurse for attachment of Face Sheet2. Ensures completeness of dataNone2 minutesAdministrative Assistant IBilling and Claims Section3. Proceed to PHIC Section upon instruction from ward nurse that the Statement of Account is ready for release or lacking documents are required for submission.3. Informs the Ward Nurse on duty/patient’s representative that the Statement of Account is ready to releaseNone15 minutesAdministrative Assistant IBilling and Claims Section4. Affix Signature on Philhealth Claim Summary Form (CSF) and Statement of Account (SOA).4. Checks completeness of dataNone2 minuteAdministrative Assistant IBilling and Claims Section5. Submit the complete Philhealth documents/claims to the Philhealth Section.5. Receives submitted documents5.1. Ensures completeness of dataNone 3 minutesAdministrative Assistant IBilling and Claims Section6. Received their Statement of Account copy and proceed to the Medical Social Work Department for discount (Charity) and re-classification of hospital bill excess and/or proceed to the Cashier’s Office for the payment of excess.6. Issues Statement of Account6.1 Instructs to proceed to MSWD for discount Charity) and re-classification of hospital bill excess and/or proceed to the Cashier’s Office for the payment of excess.None3 minutesAdministrative Assistant IBilling and Claims SectionTotal:None35 minutes5. Processing of Refund (Petty Cash Voucher)The Cash Section is responsible for the processing of refund of clients with a valid stated reason for refund and the return of cash paid by the client. The section shall process refund if documents as follows are presented if applicable:Philhealth PBEF and Statement of Account if c/o Philhealth/NBBA note on the official receipt shall be duly signed by cost center representative stating reason for refundPharmacy will issue return slips for refund of returned drugs and medicinesA Request of refund form shall be accomplished by the client and an authorization is needed if only a representative of the patient is only present.Office or Division:Finance Division – Cash SectionClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREOfficial Receipt to be refunded (1 original copy)Cashier SectionRequest for Refund (1 original copy)Cashier SectionIdentification Cards (1 original copy)ClientPhilhealth PBEF/ Statement of Account (1 original copy)Billing and Claims SectionCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEGet a number card and wait to be called1. Receives number cardNone1 minuteAdministrative Officer IIICash SectionPresent Official Receipts with valid reason for refund2. Receives and validates Official Receipts and necessary attachments to be refundedNone2 minutesAdministrative Officer IIICash SectionSign a Request for Refund Form3. Verifies authenticity and completeness of formNone2 minutesAdministrative Officer IIICash SectionSign Petty Cash Voucher4. Receives Petty Cash VoucherNone2 minutesAdministrative Officer IIICash SectionReceive Cash5. Returns Cash amounting to refundNone2 minutesAdministrative Officer IIICash SectionTotal:None9 Minutes6. Issuance for Certificate of RemittanceA certification made by the accounting staff of the agency concerned. This certification ensures that all deductions made including government share are remitted accurately and timely to authorized remitting agency.Office or Division:Finance Division- Accounting OfficeClassificationSimple TransactionType of Transaction:G2G - Government to GovernmentWho may avail:Internal Clients/ITRMC employeeCHECKLIST OF REQUIREMENTSWHERE TO SECURERequest Form (1 original copy)Accounting OfficeCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Request for certificate of Remittance for GSIS, Pag-IBIG, Philhealth and other Deductions from payroll through request slip1. Prepares Remittance request form to be given to the requesteeNone 1 minuteAdministrative Officer IIAccounting Office2. Submit application to Accounting Office2. Receives the filled-out request form from the requestee and forward to the personnel-in-charge.2.1 Prepares and verifies records of remittance.2.2 Encodes Certification and indicate all necessary information of the remittance requested.2.4 Forwards the certification to the Accountant.2.5 Reviews and signs the contents of the Certification.2.6 Forwards the certification to the HRMO (Human Resource Management Officer).2.7 Reviews and signs the contents of the Certification.2.8 Records the Certification in the logbook.2.9 Informs the requestee of the availability of Certification.None 1 dayAdministrative Officer IIAccounting OfficeAccountant IVAccounting OfficeAdministrative Officer IIAccounting OfficeAdministrative Officer IIAccounting OfficeSupervising OfficerHRMOAdministrative Officer IIAccounting OfficeSupervising OfficerHRMOAdministrative Officer IIAccounting OfficeAdministrative Officer IIAccounting Office3. Receive requested certification3. Releases the certificationNone 1 minuteAdministrative Officer IIAccounting OfficeTotal:None 1 day and 2 minutes?Finance DivisionNon-Frontline Services1. Disbursement to Internal CreditorsThe Cash Section is responsible for the releasing of checks to internal creditors in payment of various expenses and obligations.Office or Division:Finance Division – Cash SectionClassification:Simple TransactionType of Transaction:G2G- Government to GovernmentWho may avail:ITRMC EmployeeCHECKLIST OF REQUIREMENTSWHERE TO SECUREITRMC ID/Government Issued ID (1 photocopy)ITRMC EmployeeAuthorization Letter (1 original copy)ITRMC EmployeeCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1.Sign in the logbook1. Provides logbook for creditorsNone1 minuteAdministrative Officer ICash Section2.Present authenticity of ITRMC ID/Company ID and authorization if client is a representative2. Receives and verifies authenticity of presented documents and check for completenessNone1 minuteAdministrative Officer ICash Section3.Wait for the retrieval of check/LDDAP and disbursement voucher3. Retrieves Check and Disbursement VoucherNone2 minutesAdministrative Officer ICash Section4.Sign necessary parts in the disbursement voucher4. Guide client in areas for signatureNone1 minuteAdministrative Officer ICash SectionTotal:None 5 minutes2. Request for Certificate of Availability of Fund (CAF)A certification made by the proper accounting official of the agency concerned that funds have been duly appropriated/ allotted for the purpose of entering into a contract involving expenditure of public funds and that the amount necessary to cover the proposed contract for the current fiscal year is available for expenditure on account thereof, as verified by the Auditor concerned, pursuant to Section 86 of PD 1445. The CAF is required for purposes of entering into contracts for certain types of expenditures and is an integral part of the contract. On the other hand, the certification as to availability of funds contained in the Obligation Request and Status, is required for all types of expenditures and is the basis for taking up all obligations incurred in the books of accounts but is not integral part of the contract.Office or Division:Finance Division- Budget OfficeClassificationSimple TransactionType of Transaction:G2G - Government to GovernmentWho may avail:ITRMC End-User / Procurement Office PersonnelCHECKLIST OF REQUIREMENTSWHERE TO SECUREApproved Purchase Request for supplies & materials including equipment (1 original copy)Office/Department concernedApproved Program of Work for Infrastructure (1 original copy)Office/Department concernedApproved Job Order for repairs (1 original copy)Office/Department concernedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit documentary requirements to the Budget Office with the recommendation of the Financial and Management Officer1.Receives the documentary requirements and reviewNone18 minutesAdministrative OfficerBudget Office1.1 Checks for Availability of FundSupervising Administrative OfficerBudget Office1.2 Prepares Certificate of Availability of FundAdministrative OfficerBudget Office1.3 For verification and signature of Budget OfficerSupervising Administrative OfficerBudget Office1.4 Records in the logbook to be forwarded to Accounting Office and FMO for signatureChief Accountant. Finance Management Office1.5 Receives signed CAF from the FMOAdministrative AssistantBudget Section2. Receive requested CAF2. Records CAF in the logbook and forward to the requesting end-user.none7 minutesAdministrative AssistantBudget SectionTotal:None 25 minutes?Hospital Operations and Patient Support ServiceFrontline Services1. Acquisition of Bidding DocumentsThis process encompasses the acquisition of Bidding Documents. Bidding documents are documents issued by the Procuring Entity to provide the prospective bidders all the necessary information that they need to prepare their bids.Office or Division: HOPSS- Bids and Awards Committee (BAC) SectionClassification:Simple TransactionType of Transaction:G2B- Government to BusinessWho may avail:Prospective Bidders/ SuppliersCHECKLIST OF REQUIREMENTSWHERE TO SECUREOfficial Receipt (1 original copy)CashierCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Check for posted Invitation to Bid at the PhilGeps Website, Agency Website and Procurement Section Advertisement Bulletin Board1. Posts the Invitation to Bid in the PhilGeps website, Procurement Section Advertisement Bulletin Board and Agency website.None5 minutesBAC SecretariatBAC Section2. Pay the corresponding Bidding Documents Fee2. Issues charge slip and the supplier will pay corresponding fee at Cashier’s OfficeSee the table below for the matrix10 minutesBAC SecretariatBAC Section3. Present the Official Receipt and Log in to the Bidding Document Issuance Logbook3. Retains a copy of the Official ReceiptNone5 minutesBAC SecretariatBAC Section4. Receipt of the Bidding Document4. Releases of Bidding DocumentNone5 minutesBAC SecretariatBAC SectionTotal:See the table below for the matrix25 minutesMATRIX Approved Budget for the ContractMaximum Cost of Bidding DocumentsPhp500,000 and below500More than 500,000 up to 1 Million1,000.00More than 1 Million up to 2 Million2,000.00More than 2 Million up to 3 Million3,000.00More than 3 Million up to 4 Million4,000.00More than 4 Million up to 5 Million5,000.00More than 5 Million up to 6 Million6,000.00More than 6 Million up to 7 Million7,000.00More than 7 Million up to 8 Million8,000.00More than 8 Million up to 9 Million9,000.00More than 9 Million up to 10 Million10,000.00More than 10 Million up to 50 Million25,000.00>10M to 20M13,750.00>20M to 30M17,500.00>30M to 40M21,250.00>40M to 50M25,000.00More than 50 Million up to 500 Million50,000.00>50M to 100M30,000.00>100M to 200M35,000.00>200M to 300M40,000.00>300M to 400M45,000.00>400M to 500M50,000.00More than 500 Million75,000.002. Issuance of Notice of AwardThis process encompasses the issuance of notice of awards.Office or Division:HOPSS- Bids and Awards Committee SectionClassification:Simple Transaction Type of Transaction:G2B- Government to BusinessWho may avail:Prospective Bidders/ SuppliersCHECKLIST OF REQUIREMENTSWHERE TO SECURESituational Requirements:Government Issued ID (1 photocopy)Special Power of Attorney (1 original copy)Authorization Letter from the Company (1 original copy)Client’s CompanyCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1.Pick-up the Notice of Award 1. Releases Notice of AwardNone5 minutesBAC SecretariatBAC Section2. Sign/Confirm Notice of Award and return to BAC office2. Receive confirmed/signed Notice of AwardNone5 minutesBAC SecretariatBAC SectionTotal:None10 minutes3. Receiving and Processing of ApplicationsThis is the flow of receiving and processing of applications according to the CSC rules and regulations.Office or Division:HOPSS- Human Resource Management OfficeClassification:Highly Technical TransactionType of Transaction:G2C- Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREResume/ Application Letter (1 scanned copy)Applicant CSC Form 212 Personal Data Sheet (1 scanned copy)Human Resource Management/ CSC WebsiteSituational Requirements:CSC Eligibility (1 scanned copy) PRC License (1 scanned copy)Diploma (1 scanned copy) Transcript of Record (1 scanned copy) Certificate of Training/s (1 scanned copy)Civil Service Commission Philippine Regulatory Board Graduated school/ universityGraduated school/ universityApplicantCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Send application thru e-mail with complete requirements.1. Accepts/ receives/ prints application letter with documentary requirements1.1 Prepare profiling after deadline of submissionNone5 minutes10 daysAdministrative Officer IIHR Office2. Wait for the notification thru SMS/ call for schedule of the Division Pre-screening evaluation.2. Notifies applicant/s for Pre-screening.None5 daysAdministrative AssistantDepartment Secretaries3. After passing the Pre-screening evaluation, wait for notification for the Final Interview.3. Notifies applicant/s for Final Interview thru SMS/ Call/ E-mail.None60 working daysAdministrative Officer IIIHR Office4. Successful/ chosen applicants will be notified.Prepare congratulatory/ Regret LetterNone30 working days after submission of HRMPSB/ HMCC ResolutionAdministrative Officer IIIHR OfficeTotal:None 105 days and 10 minutes4. Request for Abstract of Bid/ Minutes of Pre-Bid ConferenceThis is the process of requesting for Abstract of Bid/ minutes of Pre-Bid Conference.Office or Division:HOPSS- Bid and Awards Committee SectionClassification:Complex TransactionType of Transaction:G2B –Government to BusinessWho may avail:Prospective Bidders/ SuppliersCHECKLIST OF REQUIREMENTSWHERE TO SECUREWritten Request (1 original copy)Requesting PartyCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit written request with accomplished Freedom of Information Request Form1. Receives written request and forwards it to Chief of Administrative Office for approval None6 daysBAC Secretariat, Chief Administrative Officer, Data StewardReceive the requested documentReleases of the requested documentNone3 minutesBAC SecretariatBAC SectionTotal:None6 days and 3 minutesHospital Operations and Patient Support ServiceNon- Frontline Services1. Collection, Preparation and Evaluation of the Result of Customer Satisfaction SurveyThis Process defines how the Chief Administrative Officers Staff collate and prepares the Customer Satisfaction Survey Report from the different offices of the hospital. The cut off period is every 25th of the month.Office or Division:Hospital Operations and Patient Support Service (HOPSS)Classification:Complex TransactionType of Transaction:G2G – Government to GovernmentWho may avail:ITRMC EmployeeCHECKLIST OF REQUIREMENTSWHERE TO SECURECustomer Satisfaction Survey Form (1 original copy)Any Office/ Unit/ Section CLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TimePERSON RESPONSIBLE1. Submit their Customer Feedback Report for the month at the Office of the Chief Administrative Officer1Gathers Reports of Customer Feedback from the different sections within three (3) days after the cut off period.None3 daysAdministrative Assistant IIIHOPSS1.1Consolidates the Customer Feedback Reports from the different offices and prepares the Monthly Consolidated Report of Customer FeedbackNone1 dayAdministrative Assistant IIIHOPSS1.2Reviews and assesses the Monthly Consolidated Report of Customer Feedback and the Customer Feedback Form Comments/Feedbacks/ Suggestions Report before signingNone15 minutesAdministrative Assistant IIIHOPSS1.3Submits report to the MCC for approvalNone10minutesAdministrative Assistant IIIHOPSS1.4Submits Approved Monthly Report of Customer Feedback to the ISO Head on or before the 5th day of the following monthNone10minutesAdministrative Assistant IIIHOPSSTotal:None 5 days and 35 minutes2. Issuance of Certification of Employment, Service Record, ID, IPCR, PDS, BIR Form 2316, Pay Slip, ClearanceThis is the process of issuance of certificates along with Certificate of Employment, Service Record, ID, IPCR, PDS, BIR Form 2316, Pay Slip, Clearance.Office or Division:HOPSS- Human Resource ManagementClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to GovernmentWho may avail:Present and previous ITRMC employeesCHECKLIST OF REQUIREMENTSWHERE TO SECURERequest Slip (1 original copy)Human Resource ManagementCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit Request Slip indicating the purpose1. Prepares requested document/sNone1dayAdministrative Officer IIHR Office2. Receives document/s2. Releases signed document/sNone5 minutesAdministrative Officer IIHR OfficeTotal:None1 day and 5 minutes3. Issuance of Newly Sewed Linens This Department / Section provide linen and laundry services and ensures adequate supply of clean linens for patients and other hospital units.Office or Division:HOPSS- Linen and Laundry SectionClassification:Simple TransactionType of Transaction:G2G – Government to GovernmentWho may avail:ITRMC EmployeeCHECKLIST OF REQUIREMENTSWHERE TO SECUREJob Order (2 original copies)Different wards/ department/ unitsRequisition and Issue Slip (RIS) (2 original copies)Different wards/ department/ unitsCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit RIS for required linen1. Checks availability of linen and issues requested linenNone6 hours and 15 minutesLinen Worker ILinen and Laundry SectionCuts the cloth for the requested linen Sews the requested linenMarks/ prints name of wards& logo on the new sewed linens Irons and folds new sewed linens2. Receive requested RIS2. Issues the newly sewed and folded linens to the concerned ward/ unitNone1 hourLinen Worker IILinen and Laundry Section2.1 Shall record issuance and update Total:None7 hours and 15 minutes4. Issuance of Requested Supplies/EquipmentThis is the process of releasing or dispensing supplies or equipment, for official purposes only.Office or Division:HOPSS- Materials Management OfficeClassification:Simple TransactionType of Transaction:G2G-Government to GovernmentWho may avail:ITRMC End-Users, ITRMC Central Sterile Supply (CSR) PersonnelCHECKLIST OF REQUIREMENTSWHERE TO SECUREApproved Requisition and Issuance Slip (RIS) (2 original copies)ITRMC End-Users/ITRMC Central Sterile Supply (CSR)CLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1 Forward and leave the approved RIS1.Receives request1.1 Prepares requested supplies/equipment1.2. Prepares Property Acknowledgment Receipt (PAR) for equipment and Inventory Custodian Slip (ICS) for semi expendable items1.3. Informs the end-users/CSR to pick-up the supplies/equipmentNone4 hoursAdministrative Assistant IIMaterials Management Office2. Receive supplies/equipment and signs the RIS (“received portion”)2. Issues the supplies/equipment and signs the RIS (“issued portion”)None5 minutesAdministrative Assistant IIMaterials Management OfficeTotal:None4 hours and 5 minutes5. Processing of Documents in the Office of the Chief Administrative OfficerThe Office of the Chief Administrative Officer handles internal administrative management functions and provides logistics and resources for a continuous and uninterrupted delivery of services such as human resource management, procurement, property and supply management, central information management, material management, engineering and general services. This Process defines how the Chief Administrative Officers Staff handles internal and external documents/communications from receiving, recording, to action taken and disseminating documents and information to concerned offices/person. Office or Division:Hospital Operations and Patient Support ServiceClassification:Simple TransactionType of Transaction:G2G – Government to GovernmentWho may avail:ITRMC EmployeeCHECKLIST OF REQUIREMENTSWHERE TO SECURESituational Requirements:Disbursement Vouchers/ Purchase Order Obligations (1original copy)Accounting Office, Budget Office, Materials Management Office Purchase Requests (6 original copies)All Offices/Wards/SectionsRequisition and Issue Slip (6 original copies)All Offices/Wards/SectionsJob Order Request (4 original copies)All Offices/Wards/SectionsReports (1original copy)All HOPSS SectionsChecks (1 original copy)CashierCommunication Letters (1 original copy)Medical Center Chief OfficeCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Forward the document / communication to the Office of the Chief Administrative Officer 1 Checks, receives and records the documents for review / evaluation / assessment / action of the Chief Administrative Officer.None50 minutesAdministrative AssistantHOPSS1.1 Signs or affixes initial / review, assess problems/issues and/or takes action on the submitted documents and forwards to releasing staff. 1.2 Release / disseminate to concerned section/ unit/ person the documents acted upon by CAO.2. Receive approved documents2. Records in the logbookNone5 minutesAdministrative AssistantHOPSSTotal:None55 minutes6. Processing of Soiled LinensThis Process defines the collection and laundry of soiled linen from the different wards and offices of the hospital.Office or Division:HOPSS-Linen and Laundry SectionClassification:Simple TransactionType of Transaction:G2C – Government to GovernmentWho may avail:ITRMC EmployeeCHECKLIST OF REQUIREMENTSWHERE TO SECURERequisition and Issue Slip (RIS) (2 original copies)From the different wards/ department/ units CLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submits soiled linens to the Laundry Section1.Receives and counts properly segregated soiled linensNone7 hoursLaundry Worker IILinen and Laundry Section1.1Sorts linens accordingly (clean or infectious) using appropriate Personal Protective Equipment (PPE)1.2Records accounted linen from the wards/ units and inform Nursing Attendant unaccounted or missing linen1.3Forwards the soiled linens to the laundry area.1.4Wears PPE’s then disinfect and wash spoiled linen1.5Irons, folds and sorts linens1.7Issues the clean and folded linens to the ward/ units/ section2. Receives the requested lined2. Records in the logbookNone5 minutesLaundry Worker IILinen and Laundry SectionTotalNone 7 hours and 5 minutes7. Receiving of Records for Safekeeping/StorageUnder Article 133 of RA 9470 and its IRR, otherwise known as the national archives of the Philippines act of 2007 all public records of the government, whether national or local, and the political subdivisions thereof shall be kept in facilities maintained by the agencies and offices responsible for the creation and maintenance of such records. The Non-Medical Records Section accepts all Non-Medical Records such as Hospital Issuances, Contracts, Personnel File and all other inventoried non-medical records as identified by the hospital for safekeeping and storage.Office or Division:HOPSS-Non-Medical Records SectionClassificationComplex TransactionType of Transaction:G2G -Government to GovernmentWho may avail:ITRMC Division/ SectionCHECKLIST OF REQUIREMENTSWHERE TO SECUREApproved and properly filled out NAP Form 1-2008 Records Inventory and Appraisal (1 original copy)Requesting PartyCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Shall register on the logbook of documents for safekeeping/storage1. Checks completion of registration logbookNone 5 minutesAdministrative Aide IINon-Medical Records Section2. Submit properly filled out NAP Form 1 2018 otherwise known as Records Inventory and Appraisal2. Receives properly filled out/signed formNone 7 hours Administrative Aide IINon-Medical Records Section2.1. Receives and records documents for safekeeping2.2. Inspects/ reviews documents for safekeeping2.3. Sorts and files the records in their respective file rack and labeled with stickerTotalNone 7 hours and 5 minutesMedical DivisionFrontline Services1. Application for Medical Social ServicesThis service is to evaluate and classify patients seeking admission or treatment in hospitals to determine his/her eligibility for medical social services in accordance with AO 51-A s. 2001 and AO. 31 s. 2015Office or Division:Medical Social Work DepartmentClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREHospital Bill/Charge Slip (1 original copy)Philhealth/ Billing SectionsCost Centers- (Pharmacy, Radiology, Laboratory, Dental, Emergency and Out Patient Department)MSWD Classification Card (Yellow Card) (1 original copy)Attending Social WorkerSituational Requirements:PWD/ Senior Citizen ID (1 original copy)Municipal/City Social Welfare and Development/Office of the Senior Citizen AffairBarangay Official ID/Certification (1 original copy)Department of the Interior and Local Government/Municipal Comelec officeNational Athletes Endorsement Letter (1 original copy)Games and Amusement BoardPublic Health ID (As Needed) (1 copy)Health Care FacilityCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Present the required documents 1.Receives Clients and accepts documents presentedNone2 minutesMSWD StaffMSWD2. Submit Self for interview and Assessment2. Conducts interview and assessment according to the needs of the client.2.1 Classifies patient based from the existing laws and mandates covering their medical benefits and privileges.2.2 Conducts Psychosocial management if needed.2.3. Issues classification Card (yellow Card)None15 MinutesMSWD StaffMSWD 3. Received MSWD Classification Card (Yellow Card)3. Instructs to proceed any Cost CentersNone 3 minutesMSWD StaffMSWDTotalNone 20 Minutes2. Availing of Dental ServicesThe Dental Department is mandated to provide dental consultation and treatments from general dentistry, pediatric dentistry, cosmetic dentistry, dental implants, orthodontics to root canal treatment. Office or Division:Dental Medicine Department Classification:Simple TransactionType of Transaction:G2C- Government to Citizen/ G2G- Government to GovernmentWho may avail:All Dental PatientCHECKLIST OF REQUIREMENTSWHERE TO SECURETriage Checklist and Time Monitoring Sheet (1 original copy)Dental Medicine DepartmentHealth Declaration Form (1 original copy)Dental Medicine DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Proceed window one (1) to fill up the Triage Checklist and Time Monitoring Sheet and indicate your chief complaint.1. Registers and tells to wait for his/her name to be called. None5 minutesDental AideDental Medicine2. Proceed to dental clinic to take your vital signs.2. Taking of patient vital signs and assists him/her at designated dental chair.None5 minutesDental AideDental Medicine3. Proceed to designated dental chair for further evaluation of your chief complain.3. Conducts the necessary oral examination using the Prescribed Dental Health Record and Discuss the treatment plan.None10 minutesDentistDental Medicine4. Wait for the Preparation of necessary instruments intended for your treatment.4. Subjects self to examination, treatment procedure, laboratories and other ancillary procedures.NoneTime based on procedure availed (See the table below)DentistDental Medicine5. Receive advise and home care instructions5. Provides health teaching to the patient or to parents/ guardian regarding the treatment done esp. if patient needs follow treatmentAmount based on availed procedure10 minutesDentistDental Medicine6. Receive charge slip6. Prepare charge slip and advise patient to settle at the cashier.None10 minutesDental AideDental Medicine 7. Receive official receipt7. Gives the copy of official receipt at the registration window for record purposesNone5 minutesDental AideDental MedicineTotalP50.00 (except for PWD, Senior Citizen, NBB and Indigent)+ Procedure(s) done = Total Payment50 minutes+ Time of the procedure(s) done (See table below) = Total Time of TransactionDENTAL MEDICINE DEPARTMENTCharges And Processing Time of Each PROCEDURESPROCEDURESPROCESSING TIMECHARGESDental Consultation5 MinutesP 50.00Oral Prophylaxis60 MinutesP 300.00Dental Restoration60 MinutesP 300.00/ SurfacePeriapical-Xray45 MinutesP 250.00Odontectomy180 MinutesP 5000.00Tooth Extraction60 MinutesP 150.00Fluoride Varnish15 MinutesP 50.00Removal Of Suture5 MinutesFREE3. Blood Donation (Voluntary)This involves storage of blood units, compatibility testing & antibody screening, testing for transfusion transmissible infection and releasing of blood units to In-patients.This service is available from Monday to Sunday, 24/7. Donor’s written Parent or Legally Authorized Representative (LAR) Consent for a blood donor who is not of legal age (less than 18 years old)Office or Division:Medical Division-National Voluntary Blood Services ProgramClassification:Simple TransactionType of Transaction:G2C– Government to Citizen / G2G- Government to GovernmentWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREDonor History Questionnaire Form (1 original copy)ITRMC – NVBSPValid ID (1 original copy) Any Government Agencies Issuing valid IDDonor’s Written Parent or Legally Authorized Representative (LAR) Consent (1 original copy)ITRMC-NVBSPCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Get queuing number with Blood Donor History Questionnaire (BDHQ) Form.1.1 Fill up the Blood Donor History Questionnaire (BDHQ) form.1.2 Submit Blood Donor History Questionnaire (BDHQ) form to the Blood Bank staff and present valid Identification Card with picture and signature when asked by the blood service facility personnel.1. Hands out Blood Donor History Questionnaire (BDHQ) form to the donor and emphasize the required fields to be filled up.1.1 Advises the patient to be seated at the waiting area.1.2 Verifies general data in the Blood Donor History Questionnaire (BDHQ) Form and check the completion of data and ask for a valid identification card from the blood donor for identification purposes.None15 minutesMedical Blood Bank personnel (Nurse/ Medical Technologist)2. Receive Interview, taking of vital signs2. Conducts the following:?Donor Interview?Vital Signs taking?Physical Examination2.1Blood Bank Medical Technologist conducts the following:?ABO/RH Typing?Hemoglobin TestingNone20 minutesBlood Bank Nurse/Medical Officer3. Wait for the number and full name of the blood donor to be called by the Medical Technologist and proceed to the designated bleeding chair. 3.Phlebotomy/ Extraction of blood Note: If a donor is fit to donate blood, donor is advised by the phlebotomist on the benefits of voluntary non-remunerated blood donation, retention and post-care.None15 minutesBlood Bank Nurse/ Medical TechnologistNVBSP4 Blood donor rests for at least 10 minutes under the watchful care of a Blood Bank staff.4. Assesses the blood donor if he/she feels well before allowing him/her to leave the Blood Service Facility.None10 minutesBlood Bank Nurse/ Medical TechnologistNVBSPTotalNone1 hour4. Consultation for Clients with OPD Online Appointment Identification Card Out Patient Department is the section of the hospital where patients are provided medical consultations and other services. Online appointment is required due to the impact of COVID 19 pandemic.Office or Division:Medical Division- Out Patient DepartmentClassification:Simple TransactionType of Transaction:G2C-Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREHealth Declaration Form (1 original copy)ITRMC Triage 1Triage Slip (1 original copy)OPD Triage 2OPD Record (1 original copy)ITRMC OPD Registration AreaSituational Requirement:Senior Citizen IDPerson with Disability (PWD) ID OSCA of their municipality where the client residesMSWD of their municipality where the client residesCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit self for Health Declaration and validation of appointment at the Triage 11. Properly asks patient for any signs and symptoms of related COVID 19 1.1 Instructs patient to wear mask at all times, maintain social distancing, and sanitize hand 1.2. Instructs patient to proceed to OPD None5 minutesTriage OfficerDRMHH2. Proceed to OPD triage for revalidation of Health Declaration and room assignment for consultation 2. Properly asks patient for any signs and symptoms of related COVID 192.1 Instructs patient to wear mask at all times, maintain social distancing, and sanitize hand2.2 Validates and confirms appointment ID2.3. Properly decks patient to corresponding service2.4 Instructs patient to fill up necessary data needed for registrationNone3 minuteTriage NurseOPD3. Proceed to vital sign area for vital signs taking such as Blood Pressure (BP), weight, height, Respiratory Rate (RR), Pulse Rate (PR) and Body Temperature.3. Performs proper vital signs taking. (BP, RR. PR, TEMP,WT,HT )3.1 Instructs patient to proceed to window 9 for registrationNone4 minutesNursing AttendantOPD4. Proceed to Registration Area at Room Number 9 for registration. 4.Properly registers the information of the patient and the area of service4.1 Collects the Registration Fee and issue Receipt4.2. Instructs Patient to proceed at the designated room for consultation.P 50.00Note: No Fee for Senior Citizen, PWD,and Indigent 5 minutesRegistration ClerkOPD5. Subject self for consultation and examination by the physician5.Instructs patient to wait outside and to enter the clinic once the name is called by the physician or nurse for examination5.1 OPD physician will assess patient condition 5.2. Instructs patient for necessary test if necessary NoneNoneNone1 minute25 minutes5 minutesNurse In ChargeOPDMedical OfficerOPDMedical OfficerOPD6. Subject self for treatment procedure, laboratories and other ancillary procedures as needed6. Instructs patients to proceed to proceed to the designated area of test if necessary6.1. Instructs patient to proceed to other designated clinic if necessary6.2 Issues Charge Slip to the patient if necessaryDepends on the procedureNoneRefer to Table of Fees below 65 minutes5 minutes5 minutesNurse In ChargeOPDMedical OfficerOPDNurse In ChargeOPD7. Present the charge slip to the collection officer at the Cashier Area and pay the corresponding amount7. Processes the fee and issues receiptRefer to Table of Fees below5 minutesCollection Officer8. Obtain further instruction from the doctor as to treatment plan (includes medication, etc.) before going home.8. Obtains further instructions from the doctor as to treatment plan (includes medications, etc.) before going home.None3 minutesMedical Officer/Nurse in ChargeOPDTotal P 50.00 Consultation Fee(Except for Senior Citizen, Indigent & PWD)+ Amount of procedure (Refer to table of fees below) = Total fees to be paid1 hour and 30 minutes+ time of procedure (if done)OUT PATIENT DEPARTMENT PRICE LIST OF PROCEDURESPROCEDURECHARGESOpd Consultation FeeP 50.00 (Except for Senior Citizen, Indigent ,and PWD)12 Lead or 15 Lead ECGP 250.00Intravenous (Iv)InsertionP 70.00Intravenous (Iv) PushP 70.00Intramuscular (Im) InjectionP 50.00Intradermal(Id) InjectionP 50.00NebulizationP 50.00Cbg TakingP 70.00Femoral Catheter InsertionP 650.00Bone Marrow AspirationP 100.00Intrathecal MethotrexateP 100.00OB-GYNE PROCEDURESEndometrial BiopsyP 1250.00Completion CurretageP 1250.00Manual Vacuum AspirationP 1250.00PolypectomyP 650.00ColposcopyP 1250.00Internal ExaminationP 50.00Removal Of SutureP 50.00Cauterization Of WartsP 650.00Pap SmearP 120.00Gram Staining, KohP 120.00SURGERY PROCEDURESExcisionP 650.00Excision BiopsyP 750.00Excision Of Breast MassP 750.00Cauterization P 250.00Core Needle BiopsyP 350.00Fine Needle Aspiration BiposyP 350.00CircumcisionP 500.00DebridementP 300.00Digital Rectal ExaminationP 50.00Removal Of Foreign BodyP 650.00Removal Of IngrownP 300.00Removal Of Skin Tag P 300.00 Suturing Of Wound P 250.00/ 100.00Wound DressingP 50.00/ 100.00/ 150.00Incision And DrainageP 300.00ORTHOPEDICS PROCEDURESCastingP 100.00Removal Of CastP 100.00Amputation CompletionP 650.00ENT PROCEDURESEar FlushingP 100.00Closed Reduction Of Nasal BoneP 350.00ExcisionP 650.005. Consultation for Referred Cancer or Hematology Out-PatientOncology Clinic (New ER - 2nd Floor) opens every Monday-Wednesday-Friday.Monday (8:00 – 12nn Pedia Hema-Onco), Wednesday (8:00 – 3:00 Med Onco/ Med Hema) and Friday (8:00 – 12nn Med Onco)Office or Division:Medical Division-Oncology UnitClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:All cancer patient requiring Medical Oncology and Hematology Consultation including patient.CHECKLIST OF REQUIREMENTSWHERE TO SECUREAccomplished Patient Personal Profile/Blue Card (1 original copy)Oncology Unit RegistrationOPD Patient Record (1 original copy)Oncology Unit RegistrationSituational Reuirements:Diagnostic Test/Imaging Results (1 original copy)Laboratory Department/Radiology DepartmentBiopsy Result/Histopathology Result/BMA Result (1 original copy)Laboratory DepartmentReferral Form (1original copy)From Concerned DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Present Referral FormReceives and validate the referral form.1.1 Queues patient for consultation.1.2 Instructs patient and watcher to wait until the name is called and enter the clinic once name is called.None1 HourMedical Specialist/Medical OfficerNursing AttendantNursing AttendantOncology Unit2. Consult with the Physician. 2. Conducts thorough history taking and perform physical examination if needed.2.1 Explains findings, management and plans for the patient.2.2 Gives patient a prescription and diagnostic request if necessary. 2.3 Schedules patient for next follow up.None30 minutesMedical Specialist/Medical OfficerOncology UnitTotal None1 hour and 30 minutes6. Consultation for Clients Using E-KonsultaThis is an online platform for appointment of patients who wish to consult at the Out -Patient department of the hospital.Office or Division:Medical Division- Out-Patient DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2C- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREELECTRONIC DIAGNOSTIC REQUEST FORM (Imaging request, laboratory request) (1 photocopy)doctor.itrmc.onlineREGISTRATION CODE (1 photocopy)doctor.itrmc.onlineCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Visit the E-konsulta website and reads the procedure in the conduct of online consultation which is in either English or Tagalog1.1 Clicks the link for the online registration website 1.2 Fill-up the necessary details being asked such as preferred online consultation system, personal details of patient, address of patient, and details of consultation1.3 Reads, understands and agrees with the terms and conditions of the online consultation1.4 Reads, understands and agrees with the data privacy of the online consultation1.5 Verify the details provided, and if already verified, clicks the register button.1.6 Click the link of the Facebook Messenger of the selected Department1. Opens the online registration website through an admin portal1.1 Gives Registration Code valid only for the day, 1.2 Provides the link of the Facebook Messenger of the selected DepartmentNone10 minutesAdministrative AssistantOPD2. Shall undergo COVID-19 Pre-Screening before online consultation proper by following the guided instructions by the Automated Facebook Messenger Chat Bot2. Guides the patient if the Automated Chat Bot recommends referral to COVID-19 Hotline.2.1 Coordinates patient to the COVID-19 Hotline if neededNone5 minutesMedical OfficerOPD3. Subject self for virtual consultation and examination by the physician3. Gets and verifies the registration code of the patient before conducting the online consultation proper.3.1 Conducts history taking and virtual physical examination by requesting the patient to send essential images of body parts needed for appropriate diagnosis and management.3.2 Also refers patient through intradepartmental (within the same department) or interdepartmental (within other departments of ITRMC) as necessary.3.4 Issues electronic laboratory requests if necessaryNone30minutesMedical OfficerOPD4. Obtain further instruction from the doctor. 4. Consultation Shall advise patient on proper medications and other health related patient educationShall advise patient to follow – up if necessaryShall advise patient to visit nearest hospital or health care facility if symptoms persisted or worsens4.1 Consulted and Given OPD AppointmentShall make OPD appointment schedule and gives to patient the appointment schedule and advise accordingly4.2 Referred to COVID-19 HotlinesShall coordinate with the ITRMC COVID-Hotlines4.3 Advises consult to ITRMC Emergency RoomShall give electronic referral form through saved referral form template3.4 Advises consult to Nearest Hospital or Health Care Facility4.4 Gives electronic referral form through saved referral form templateNone20 minutesMedical OfficerOPD5. Answer the Customer Satisfaction Feedback Online Form 5. Shall send the link of the customer satisfaction feedback online form to the patientNone10 minutesMedical OfficerOPDTotal None 1 hour 25 minutes7. Collection/ Receiving of Specimens (Body Tissues, Body Fluids) for Processing, Storage and TestingA medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease.Office or Division:Medical Division-Laboratory DepartmentClassification:Simple TransactionType of Transaction:G2C– Government to Citizen / G2G- Government to Government/G2B- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECURELaboratory Request/ Specimen (1 original copy)ITRMC – Laboratory ReceptionOfficial Receipt/ claim stub (1 original copy)ITRMC Cost CentersCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Get a number from the assigned laneRegular LanePriority Lane1.1. Submit laboratory request and/or specimen at the reception area1. Advises the patient to be seated at the waiting area1.1. Verify general data in the laboratory request and check the specimen submitted1.2 Attach the charge slip and claim stub in the laboratory request and forward to the phlebotomistNone15 minutesMedical TechnologistLaboratory Department2. Blood extraction and/or Specimen collection2. Charge slip and claim stub given to the patient after the procedureRefer to table of fees below20 minutesMedical TechnologistLaboratory Department 3. Proceed to the cashier to pay3. Receive payment3.1 Issues official receiptRefer to table of fees below10 minutesCashier AssistantCash Section4. Claim the laboratory results by showing the official receipt and claim stub4. Checks official receipt and claim stub4.1. Releases the laboratory results to the patient based on the posted turn around None5 minutesMedical TechnologistLaboratory DepartmentTotal Amount depends on the availed examination (refer to table of fees below)50 minutesILOCOS TRANING AND REGIONAL MEDICAL CENTERDEPARTMENT OF PATHOLOGY AND LABORATORY SERVICESLABORATORY EXAMINATION PRICE LISTBLOOD BANK ( BB )EXAMINATIONPRICE??Crossmatching400Direct Coomb's Test300Indirect Coomb's Test300Reverse Typing100CLINICAL CHEMISTRY ( CC )2 Hour PPBS15024 Hour Urine Creatinine Clearance30024 Hour Urine Protein250ALP400Amylase250Bilirubin ( TB, B1, B2 )400 - Direct Bilirubin ( B1 )150 - Indirect Bilirubin ( B2 )400 - Total Bilirubin ( TB )150BUA150BUN150Calcium, Ionized ( iCa )700Calcium, Total250Creatinine150Electrolyte Panel ( Na, K, Cl )700 - Chloride250 - Potassium250 - Sodium250Electrophoresis? - HbA1c Electrophoresis3,000? - Hemoglobin Electrophoresis3,000 -Serum Protein Electrophoresis3,000FBS150Ferritin400Glucose ( CSF & Other Body Fluid )150G6PD400HbA1c900Iron200LDH200Lipase550Lipid Profile ( Chol, Trig, HDL, LDL )550 - Cholesterol150 - Triglyceride150 - HDL250Magnesium200OGCT 50 g250OGTT 75 g / 100 g900Phosphorous200Protein ( CSF& Other Body Fluid )150Random Urine Protein250Random Urine Creatinine – Protein Ratio400RBS150SGOT ( AST )150SGPT ( ALT )150TPAG ( Total Protein, Albumin, Globulin, A/G Ratio )350 - Albumin200 -Total Protein150Urine Potassium250Urine Sodium250CLINICAL MICROSCOPY ( CM )Cell Count & Differential Count ( CSF & Other Body Fluid )150Drug Test ( Metamphetamine / THC )250Fecalysis150Micral Test200Occult Blood150Pregnancy Test150Stool Concentration Technique150Seminal Fluid Analysis200Urinalysis150Urine Ketones80Urine RBC Morphology80HEMATOLOGYABO & Rh Typing100APTT 250Bleeding Time50BMA Staining ( per slide )10CBC150CRT 150Clotting Time50ESR100LE Prep150Malarial Smear150PBS150Protime200Reticulocyte Count100Specimen Collection50HISTOPATHOLOGYAVAILABLE IMMUNOHISTOCHEMISTRY ( IHC )??Breast Panel ( ER, PR, Her2neu )4,500 - ER1,500 - Her2neu1,800 - PR1,500CD31,500CD201,500CK1,500LCA1,500IHC PATHOLOGIST READING FEE ( for private patients only )? - Brenda I. Rosuman, MD, FPSP1,000 - Cheshire Therese A. Madrid, MD, DPSP1,000 - Jimmy S. Rosales, MD, DPSP1,000?OSL IMMUNOHISTOCHEMISTRY ( IHC )??CD301,200CD991,200CD1171,200Chromogranin1,200CK71,200CK201,200Desmin1,200Mammaglobin1,200Mart-11,200Myogenin1,200P631,200Pancytokeratin1,200S1001,200SMA1,200Synaptophysin1,200TTF11,200Vimentin1,200Handling Fee ( additional charge for every patient ) – Histosolution300Handling Fee – HI PRECISION100Handling Fee – NKTI400IHC PATHOLOGIST READING FEE ( for private patients only )? - Brenda I. Rosuman, MD, FPSP1,000 - Cheshire Therese A. Madrid, MD, DPSP1,000 - Jimmy S. Rosales, MD, DPSP1,000PROCESSING FEES??Cell Block / Cytology150Cytology ( CSF )300Endoscopic / Punch Biopsies350FNAB150Frozen Section1,500Large Specimen350Medium Specimen250Pap's Smear150Small Specimen150PATHOLOGIST READING FEE ( private patients only )BMA 1,500Endoscopic / Punch Biopsies / Core Needles1,500FNAB1,500Frozen Section5,000Immunohistochemistry1,000Large Specimen ( > 7.1 cm in greatest diameter )3,500Medium Specimen ( 3.1 cm to 7.1 cm in greatest diameter )2,500Non-gynecology with Cell Block1,500Non-gynecology without Cell Block800Radical ( large specimen w/ nodal dissections, blood vessels dissection &/or involvess more than 1 type of tissue )5,000Small Specimen ( up to 3 cm in greatest diameter )800Ultrasound-guided / CT Scan-guided1,500??Consultant Pathologists? - Brenda I. Rosuman, MD, FPSP? - Cheshire Therese A. Madrid, MD, DPSP? - Jimmy S. Rosales, MD, DPSP?IMMUNOLOGY - SEROLOGY ( IS )QUALITATIVE TESTSASO Titer150CRP150Dengue IgG | IgM | NS1400H Pylori300HAV IgG | IgM700HBs Ag 150HCV250HIV250Leptospira IgG | IgM450Rf150Salmonella Typhi500Trop I380Trop T700VDRL ( Anti-Treponema Pallidum )150QUANTITATIVE TESTSAFP1,000ASO Titer350Anti - HBc IgM750Anti – Hbe700Anti – HBs500Anti – HCV750Beta HCG800C3800CA 1251,000CA 19-91,000CD4 Count1,500CEA1,000CRP500D – Dimer1,500FPSA1,200FT3600FT4600HBe Ag600HBs Ag500HIV400T3600T4600TSH700TPSA1,200Triage ( CK-MB, Myoglobin, Trop I )2,200VDRL ( Anti-Treponema Pallidum )400MICROBIOLOGYAFB75BHI Bottle1,500Cryptococcal Ag ( CALAS )1,000Culture and Sensitivity ( C & S )? - Blood C & S2,000 - Other Specimen2,500Gram Stain75India Ink75KOH75Meningitis Panel (Phadebact)2,500Water Analysis? - Bacteriological ( per bottle )600 - Physical & Chemical? - Color250 - Odor250 - Ph250National Voluntary Blood Services Program ( NVBSP )Blood Bag - Double ( 450 mL )310Blood Bag - Single ( 450 mL )145Blood Bag - Triple ( 450 mL )450Cryoprecipitate1,000Cryosupernate1,000Fresh Frozen Plasma ( FFP )1,000Packed Red Blood Cells ( PRBC )1,500Platelet Concentrate ( PC )1,000Washed Red Blood Cells1,500Whole Blood1,800TB LABDSSM150TB Culture2,5008. CoVID-19 Testing by Real Time-Polymerase Chain ReactionThe hospital received the accreditation from the Research Institute for Tropical Medicine (RITM) which is under the Department of Health. It will test swab specimens using Real Time PCR (polymerase) chain reaction. The facility will cater patients from Region 1hospitals that sends specimens to Baguio General Hospital and Medical Center (BGHMC).Office or Division:Medical Division- Laboratory DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:All clients who may want to avail the serviceCHECKLIST OF REQUIREMENTSWHERE TO SECURECase Investigation Form (CIF) Version 7 (4 original copies)ITRMC Laboratory Reception/ Official Receipt (1 original copy)ITRMC Cost CentersCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEGet an online appointmentReceives online appointment messageNone5 minutesMedical TechnologistLaboratory DepartmentPrint emailed confirmation of online appointment2. Sends confirmation email of online appointmentNone10 minutesMedical TechnologistLaboratory DepartmentSubmit emailed confirmation form to laboratory reception area on the scheduled date of swab3. Receives submitted confirmation form3.1 Instructs to accomplish CoVID-19 Case Investigation Form (CIF)None10 minutesMedical TechnologistLaboratory DepartmentSubmit Completed CoVID-19 Case Investigation Form (CIF)4. Checks and validates submitted CIF4.1 Charge CoVID-19 Testing fee and copy Official ReceiptNone10 minutesMedical TechnologistLaboratory DepartmentPay at the Cashier and present official receipt to laboratory sectionReceives payment and issues official receiptPhp 3, 500.0010 minutesAdministrative AssistantCash SectionProceed to Swab Collection Booth6.1 Collects (Nasopharyngeal/oropharyngeal swab)None2 daysMedical Technologist6.2 Analyzes collected specimenMedical TechnologistReceive swab result via emailSends test reports via e-mailNone5 minutesMedical TechnologistTotal Php 3,500.002 days and 50 minutes9. Dispensing of Medicines for OPD (Philhealth Patient, Medical Assistance)The scope of pharmacy practice includes more traditional roles such as compounding and dispensing of medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information.Office or Division:Medical Division- Pharmacy ServiceClassification:SimpleType of Transaction:G2C- Government to CitizenWho may avail:All patients who may want to avail the serviceCHECKLIST OF REQUIREMENTSWHERE TO SECUREWritten or Electronic Prescription (completely filled) (1 original copy)Prescribing DoctorSituational Requirements:MSWD classification card (1 original copy)Authorization Letter (1 original copy)CF4 form (1 original copy)Protocol of treatment is necessary for patients undergoing chemotherapy (1 original copy)MSWD office Parent/Guardian Philhealth OfficePrescribing PhysicianCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEPresent the prescription/s and the required documents to the Pharmacist. Wait for the Charge Slip1. Checks the required documents if complete.1.1 Verifies authenticity of documents presented.1.2 Prepares corresponding charge slip1.3 Instructs the client to process the documents for verification (philhealth patient)-Proceed to MSWD for medical assistance1.4 Prepares the needs of the client.None10 minutesPharmacistPharmacy SectionReturn to Pharmacy-Presentthe verified documents(PhilHealth patient) -chargeslip(for medical assistance)2. Dispenses the medicine2.1 Explains to the client the proper use of the medicine/sNone7 minutesPharmacistPharmacy SectionGet the medicine and listen to the dispensing information. Sign the chargeslip and prescription then return after signing3. Checks the completeness of the signed chargeslip and prescriptionNone1 minutePharmacistPharmacy SectionTotal: Amount will be based on the items purchased (refer to table of fees below)18 minutesPHARMACY UPDATED PRICE LIST 2020Item DescriptionUnit CostSelling Cost0.9% Sodium Chloride for irrigating 1 liter46.7758.460.9% Sodium Chloride for irrigating 500mL 54.00 67.500.9% Sodium Chloride for irrigating 50mL 44.80 56.000.9% Sodium Chloride IV Infusion 1 liter33.9842.485% Dextrose in Water IV infusion and as vehicle for IV medications 500mL (Plastic) bottle39.7649.705% Dextrose in Lactated Ringer's IV infusion 1 liter bottle/bag 38.10 47.635% Dextrose in Lactated Ringer's IV infusion 500ml bottle/bag 41.10 51.385% Dextrose in Water IV infusion and as vehicle for IV medications 250mL 48.00 60.005% Dextrose in Water IV infusion and as vehicle for IV medications 500ml glass 76.00 95.00 50% Dextrose Solution for IV Injection 50ml 50.00 62.50 50% Glucose (dextrose) (D50-50) (IV) vial, 50ml 50.00 62.50Acetazolamide 250mg 20.00 25.00Acetylcysteine 100mg 9.00 11.25Acetylcysteine 200mg8.7410.93Acetylcysteine 600mg 20.00 25.00Acetylcysteine 600mg Tablet16.05 20.06 Aciclovir 25mg/mL (IV Infusion) 10mL 22.4428.05Aciclovir 400mg 14.10 17.63Aciclovir 800mg 27.98 34.98Adenosine 3mg/ml, 2mL172.22215.28Albumin Human 20% (IV, IV Infusion) , 50 ML2,535.003168.75All-in-one Admixtures Solution Volume: 400-25--mL (protein 3-6g/100mL carbo:6-15g/100mL lipid:2-5g/100mL cal: variable electorytes: 1400 Kcal 1,545.00 1931.25All-in-one Mixtures solution Lipid Peri emulsion for Intravenous Infusion 1875ml 1,680.00 2,100.00 Alprazolam 250mcg 12.00 15.00Alprazolam 500mcg 18.00 22.50Amikacin 250mg vial (IM/IV) (as Sulfate), 2mL22.4428.05Amino Acids, Crystalline Standard 7% (IV Infusion) , 500ml 774.98 968.73Amino Acids, Crystalline Standard 8% (as branched chain) IV infusion 500mL 875.70 1094.63Amiodarone 200mg tablet9.9812.48Amiodarone 50mg/ml ampule279.00348.75Amlodipine Besylate 10mg0.380.48Amlodipine Besylate 10mg Tablet 0.50 0.63 Amlodipine Besylate 5mg0.3120.39Amlodipine Besylate 5mg Tablet 0.27 0.34 Amoxicillin Trihydrate 250mg/ml susp.15.9819.98Amoxicillin Trihydrate 500mg1.391.74Amphotericin B 50mg (IV Infusion) 10,437.0013046.25Ampicillin + Sulbactam ( as sodium salt) 500mg/ 250 per vial (IM,IV)23.4529.31Ampicillin + Sulbactam (as Sodium Salt) 250mg/125mg per vial (IM,IV) 85.00 106.25Ampicillin Sodium 500mg (IM,IV)8.3910.49Anti-rabies Serum (equine) 200IU/ml (IM) , 5ml 1,239.00 1548.75Ascorbic Acid 500mg Tablet 1.00 1.25Ascorbic Acid 500mg tablet 0.68 0.85 Aspirin 80mg 0.881.10 Aspirin 80mg Tablet 0.63 0.79 Atenolol 50mg Tablet1.401.75Atracurium Besilate 10mg/ml , 2.5mL109.88137.35Azithromycin (as base) 500mg tablet8.7810.98 Azithromycin 500mg Tablet 9.45 11.81 Azithromycin 500mg Vial 270.00 337.50 Balanced Multiple Maintenance Solution with 5% Dextrose for Adult IV infusion 1liter bottle/bag 40.00 50.00Balanced Multiple maintenance Solution with 5% Dextrose for Pedia IV Infusion 500mL34.3442.93Balanced Multiple Replacement Solution with 5% Dextrose for Pedia IV Infusion 500mL45.0056.25Benzylpenicillin 1M ampule 12.43 15.54Benzylpenicillin 5M ampule 16.34 20.43Beractant 25mg/ml suspension, 4mL 10,325.00 12906.25Betahistine Hydrochloride 24mg 21.10 26.38Betahistine Hydrochloride 8mg 6.90 8.63 Betahistine Hydrochloride 8mg tablet 5.27 6.59 Biperiden Hydrochloride 2mg4.876.09Biphasic Isophane Human Insulin 70/30 (recombinant DNA) 70% isophane suspension + 30% soluble insulin in 100IU/ml, 10ml120.00150.00Bisacaodyl 10mg Adult22.3927.99Bisacodyl 5mg 13.50 16.88 Bisacodyl 5mg tablet 1.36 1.70 Bleomycin (as sulfate) 15mg vial/ampul2,200.002750.00 Bleomycin 15mg vial 1,938.00 2,422.50 Brinzolamide eye drops1,064.001330.00Bupivacaine 0.5% (spinal) with 8% Dextrose, 4Ml78.2297.78Bupivacaine Hydrochloride 0.5% (local infiltration) 10mL92.33115.41Butamirate Citrate 50mg MR 10.49 13.11Butamirate Citrate 50MR Tablet 7.95 9.94 Calcium Carbonate 500mg 1.65 2.06Calcium Folinate (Leucovorin Calcium) 10mg/ml (IM,IV) 5mL 167.05 208.81Calcium Gluconate 10% (IV) 10mL17.2321.54 Candesartan 8mg Tablet 10.50 13.13 Capecitabine 500mg 44.0055.00 Capecitabine 500mg Tablet 37.00 46.25 Captopril 25mg 1.48 1.85Captopril 25mg Tablet 0.39 0.49 Captopril 25mg Tablet 0.39 0.49 Carbamazipine 200mg 3.80 4.75Carbidopa + Levodopa 25mg/ 100mg 15.00 18.75Carbidopa + Levodopa 25mg/ 250mg 23.95 29.94Carboplatin 150mg 780.00 975.00Carboplatin 150mg vial 899.00 1,123.75 Carboplatin 450mg 1,150.00 1437.50Carboplatin 450mg vial 1,890.00 2,362.50 Carboprost 250mcg ampule 337.88 422.35Carvedilol 25mg 5.00 6.25Carvedilol 6.25mg1.381.73Cefalexin Monohydrate 500mg 8.85 11.06 Cefazolin 1g vial 17.42 21.78 Cefazolin Sodium 1g (IM,IV) 17.2321.54 Cefepime 1g Vial 90.00 112.50 Cefepime Hydrochloride 1g (IM, IV)88.33110.41Cefepime Hydrochloride 500mg (IM,IV) 152.34190.43 Cefixime 100mg/5ml 60ml Bottle 120.00 150.00 Cefixime 200mg 6.678.34Cefixime 200mg capsule 6.50 8.13 Cefotaxime 1g vial34.8943.61Cefoxitin Sodium 1g (IM,IV) 83.33104.16Ceftazidime Pentahydrate 1g (IM,IV)41.3351.66Ceftazidime Pentahydrate 500mg (IM,IV) vial651.94814.93Ceftriaxone Disodium/ Sodium Salt 1g + 10mL diluent (IV)22.3227.90Cefuroxime 500mg Tablet 9.50 11.88 Cefuroxime Axetil 500mg 8.8811.10Cefuroxime Sodium 1.5 (IV Infusion) 98.00 122.50Cefuroxime Sodium 750mg (IM,IV) 13.8817.35Celecoxib 200mg3.103.88Celecoxib 200mg capsule 2.00 2.50 Celecoxib 400mg 9.10 11.38Cetirizine Dihydrochloride 10mg 3.42 4.28 Cetirizine Dihydrochloride 10mg Tablet 0.34 0.43 Cetirizine Dihydrochloride 10mg/ml Oral Drops, 10mL 65.56 81.95Cetirizine Dihydrochloride 5mg/5mL Syrup, 30mL 65.00 81.25Chick Embryo Cell (purified inactivated) luophilized powder, 2.5IU/ml, dose vial+ 1 mL diluent (ID, MD) 1,756.15 2195.19Chloramphenicol 0.5% Ear drops 80.00 100.00Chlorhexidine Gluconate Antiseptic: 4% solution, 120ml 139.98 174.98Chlorphenamine 10mg/ml 1ml 10.80 13.50 Chlorphenamine 10mg/ml ampule 10.80 13.50Chlorphenamine 4mg Tablet 1.00 1.25Chlorpromazine Hydrochloride 100mg1.882.35Chlorpromazine Hydrochloride 200mg3.434.29Cilostazol 50mg tablet 8.85 11.06Cilostazole 50mg Tablet 6.93 8.66 Cinnarizine 25mg Tablet 1.10 1.38 Ciprofloxacin 2mg/ml (IV Infusion) , 50ml40.0050.00Ciprofloxacin Hydrochloride 500mg1.632.04Cisplatin 1mg/ml (IV) 50mL 378.00 472.50 Clarithromycin 125mg/5ml Suspension 70ml bottle 138.00 172.50 Clarithromycin 500mg base 11.00 13.75Clindamycin 150mg capsule 3.00 3.75 Clindamycin 300mg Capsule 4.12 5.15 Clindamycin Hydrochloride 300mg 4.89 6.11Clindamycin Phosphate 150mg/ml (IM,IV), 4mL7.639.54 Clindamycin Phosphate 150mg/ml 4ml Ampule 79.50 99.38 Clonidine Hydrochloride 150mcg 23.00 28.75Clonidine Hydrochloride 75mcg5.446.80 Clonidine Hydrochloride 75mcg Tablet 6.00 7.50 Clopidogrel 75mg 1.271.59 Clopidogrel 75mg tablet 1.24 1.55 Cloxacillin (as Sodium Salt) 500mg 6.00 7.50 Cloxacillin 500mg capsule 2.60 3.25 Clozapine 25mg 18.00 22.50Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) (228.5mg)200mg+ 28.5mg per 5mL for Suspension, 70mL 115.76 144.70Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) (312.50mg)250mg+ 62.5 per 5mL granules/powder for Suspension, 60mL 109.16 136.45Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) 625mg Tablet 5.99 7.49 Co-Amoxiclav (Amoxicillin +Potassium Clavulanate ) 625mg (500mg+125mg) per tablet6.007.50Co-Amoxiclav (Amoxicillin +Potassium Clavulanate )1g (875mg+125mg) tablet11.0013.75Colchicine 500mcg 1.79 2.24Cotrimoxazole (Sulfamethoxazole + Trimethoprim) 400mg + 80mg per 5ml Suspension , 60ml 34.10 42.63Cyclophosphamide 500mg (IV) 150.00187.50Cyclophosphamide 1g (IV) 175.00218.75 Cytarabine 100mg vial 122.90 153.63 Dacarbazine 200mg (IV,IV infusion) 565.00 706.25Dacarbazine 200mg powder vial558.00 697.50 Dactinomycin (Actinomycin D) 500mf powder inj. Vial 400.00 500.00Dexamethasone (as Sodium Phosphate ) 4mg/ml (IM, IV) , 2mL11.2314.04Dexamethasone 4mg tablet30.7538.44Diazepam 5mg/ml (IM,IV) , 2mL77.3496.68Digoxin 250mcg 3.904.88Digoxin 50mcg/ml 60ml bottle716.22895.28Diltiazem 60mg Tablet3.103.88Diphenhydramine (as Hydrochloride) 50mg/ml (IM,IV) 1mL24.3230.40Diphenhydramine 50mg capsule2.182.73 Diphenhydramine 50mg Capsule 0.74 0.93 Dobutamine 50mg/ml 5ml ampule 145.35 181.69 Docetaxel (anhydrous) 20mg/0.5mL (iv Infusion),0.5mL 985.20 1231.50Docetaxel (anhydrous) 40mg/mL (iv Infusion),2mL 2,165.45 2706.81Domperidone 10mg 3.50 4.38 Domperidone 10mg tablet 1.30 1.63 Doxorubicin (as Hydrochloride) powder, 10mg 160.00 200.00Doxorubicin (as Hydrochloride) powder, 50mg 532.00 665.00Doxycycline (as Hyclate) 100mg 14.00 17.50Enalapril (as Maleate ) 5mg 5.10 6.38Enoxaparine (as Sodiu Salt) 100mg/ml Pre-filled syringe (SC) 600.00 750.00Enoxaparine (as Sodium Salt) 100mg/ml Pre-filled syringe (SC) 0.4mL 204.33255.41Enteral Nutrition Adult Polymeric,100-475 Kcal,powdder 400g191.00238.75Enteral Nutrition Diabetes,100-1000 Kcal,powder 400g260.00325.00Enteral Nutrition Fiber-containing,100-1048 Kcal,powdder 400g191.00238.75Enteral Nutrition Pediatric Polymeric 445-511 Kcal, Powder 100g380.41475.51Eperisone Hydrochloride 50mg 16.80 21.00Ephedrine Sulfate 50mg/ml , 1ml 77.5096.88Epinephrine (as Hydrochloride) 1mg/ml (IM,SC) 1mL22.3327.91Epoetin Alfa (Recombinant human erythropoetin) 4,000 IU/ml (IV,SC) , 1ml 360.00 450.00 Epoetin Alfa 4,000iu/ml pre-filled syringe 360.00 450.00 Eprirubicin ( as Hydrochloride) 10mg (IV) 657.00 821.25Eprirubicin ( as Hydrochloride) 50mg (IV) 2,678.00 3347.50Ertapenem (as sodium) powder, 1g (IM,IV) 3,088.56 3860.70Erythromycin Eye Ointment 0.005, 3.5g112.11140.14Escitalopram (as Oxalate) 10mg 3.45 4.31Etericoxib 120mg 37.0946.36 Felodipine 5mg ER tablet 7.50 9.38 Fenofibrate 145mg 26.00 32.50Fenofibrate 160mg 19.5024.38FeNtanyl (as Citrate ) 50mcg/ml, 2ml 57.3371.66Ferrous Sulfate + Folic Acid 60mg elemental iron +400mcg folic acid0.720.90Filgrastim 300mcg/ 1ml vial 918.00 1147.50 Filgrastim 300mcg/1.2ml vial 2,652.00 3,315.00 Filgrastim 300mcg/1.2ml vial 900.00 1,125.00 Finasteride 5mg 7.35 9.19Fluconazole 150mg150.00187.50Fluconazole 2mg/ml (IV Infusion) 100mL344.33430.41Fluorouracil 50mg/ml (IV,IV infusion) 10ml 75.00 93.75Fluphenazine Decanoate 25mg/ml, 1ml82.32102.90Fluticasone Nasal Spray 0.05 dose 247.79 309.74Fondaparinux ( as Sodium Salt) 2.5mg, 0.5mL 1,543.50 1929.38 Furosemide 10mg/ml 2ml Ampule 6.48 8.10 Furosemide 10mg/ml, 2mL6.327.90Furosemide 40mg Tablet0.600.75 Furosemide 40mg Tablet 1.55 1.94 Fusidate Sodium/ Fusidic Acid 2% Ointment ,5g 150.00 187.50Gabapentin 100mg 5.90 7.38Gabapentin 300mg 6.20 7.75Gadobutrol 1.0mmol/ml vial, 15ml4,000.005000.00Gemcitabine (as Hydrochloride) 1g (IV Infusion) 2,495.003118.75Gemcitabine (as Hydrochloride) 200mg (IV Infusion) 650.00812.50Gentamicin (as Sulfate) 40mg/ml (IM,IV), 2mL4.485.60 Gentamicin 40mg/ml 2ml Ampule 3.65 4.56 Gliclazide 30mg MR2.503.13Gliclazide 80mg 4.00 5.00 Gliclazide 80mg tablet 2.36 2.95 Gliclazide 80mg tablet 2.36 2.95 Haloperidol 5mg 23.85 29.81Heparin (as Sodium) 1,000 IU/mL (IV,IV Infusion, SC) 5mL42.8853.60Heparin (as Sodium) 5,000 IU/mL (IV,IV Infusion, SC) 5mL250.00312.50 Heparin 5,000IU/ml 5ml vial 160.00 200.00 Heparin 5,000IU/ml 5ml vial 140.00 175.00 Hepatitis B Immunoglobulin (Human)1,998.002497.50 Hydralazine HCI 20mg/ml 1ml Ampule 28.24 35.30 Hydralazine HCL 20mg/ml (IM,IV) 1mL38.2247.78Hydrocortisone (as Sodium Succinate ) 100mg powder (IV) 21.4326.79Hydrocortisone (as Sodium Succinate ) 250mg powder (IV) 67.7884.73 Hydrocortisone 100mg vial 22.36 27.95 Hydrocortisone 250mg vial 64.71 80.89 Hydroxyurea 500mg26.0032.50Hyoscine (as N-butyl Bromide ) 10mg Tablet 4.115.14Hyoscine (as N-butyl Bromide ) 20mg/ml (IM,IV,SC) 1mL 18.3422.93 Hysocine (as N-butyl bromide) 20mg/ml 1ml Ampule 23.53 29.41 Ibuprofen 200mg Tablet 0.95 1.19 Ifosfamide 1g (IV Infusion) 1,650.002062.50Ifosfamide 2g (IV Infusion) 2,400.003000.00Immunoglobulin, Normal Human (IGIV) 50mg/ml , 100ml9,800.0012250.00Insulin Glargine 100iu vial 337.00 421.25Intraocular Irrigating Solution (balanse Salt Solution), 500ml 420.00 525.00Ipratropium Bromide anhydrous + Salbutamol Sulfate 500 mcg + 2.5mg x 2.5 mL soln for inhalation Nebule 10.00 12.50 Ipratropium Bromide annhydrous + Salbutamol Sulfate 500mcg + 2.5mg x 2.5 mL (unit dose Respiratory solution) 13.00 16.25Irbesartan 150mg 3.784.73 Irbesartan 150mg Tablet 3.63 4.54 Irbesartan 300mg 7.20 9.00 Irbesartan 300mg Tablet 6.51 8.14 Iron Sucrose 100mg Ampule 130.00 162.50 Isoflurane 100ml1,300.001625.00Isosorbide -5- Mononitrate 30mg MR 8.00 10.00Isosorbide -5- Mononitrate 60mg MR 6.00 7.50Isosorbide Dinitrate 1mg/ml , 10ml 131.78 164.73Isosorbide Dinitrate 5mg Sublingual/ oral 2.10 2.63Isosorbide Dinitrate 5mg tablet 8.80 11.00 Isosorbide-5-Mononitrate 30mg MR 5.73 7.16 Isotonic Electrolyte Solution for IV infusion 1000ml 246.50 308.13 Isotonic Electrolyte Soulution for IV infusion Each 1L; NaCl 6.80g,KCl-0.30g, CaCl-0.37g,MgCl-0.20g,Na Acetate 3.27g,Malic Acid-0.67g 180.00 225.00Ketamine 50mg/ml ,10mL 532.32665.40Ketoconazole 15g cream115.00143.75Ketorolac Tromethamol 30mg/ml (IM,IV) 1mL 17.8822.35Lactated Ringers Solution IV Infusion , 1 liter 36.10 45.13Lactulose 3.3g/5mL (66%) Syrup 120mL Bottle 59.99 74.99 Lactulose 3.3g/5ml (66%) Syrup, 120ml 140.00 175.00Lansoprazole 30mg capsule 18.00 22.50 Lansoprazole 30mg capsule 20.90 26.13 L-Asparaginase 10000iu vial 1,689.00 2111.25Latanoprost 50mcg eye drops 700.00 875.00Leuprorelin (as Acetate) 3.75mg/2ml with syringe (IM,SC)4,800.006000.00Levofloxacin 500mg 7.00 8.75Levofloxacin 500mg IV 450.75563.44 Levofloxacin 500mg Vial 170.00 212.50 Levofloxacin 750mg 19.00 23.75Levothyroxine (as anhydrous sodium) 100mcg 6.80 8.50Levothyroxine (as anhydrous sodium) 100mcg tablet 5.50 6.88 Levothyroxine (as anhydrous sodium) 25mcg 2.80 3.50Levothyroxine (as anhydrous sodium) 50mcg tablet2.95 3.69 Levothyroxine (as anyhydrous sodium) 50mcg2.953.69Lidocaine Hydrochloride 10% spray, 50mL 2,215.46 2769.33Lidocaine Hydrochloride 2% (as hydrochloride) 5mL8.2210.28Lidocaine Hydrochloride 2% (for epidural local infiltration) ,50ml vial 50.00 62.50Lidocaine Hydrochloride 2% w/ Epinephrine 1.8ml carpule 25.50 31.88Lipids 20% (IV infusion) 250mL 749.00 936.25Loperamide Hydrochloride 2mg capsule 4.95 6.19Loratadine 10mg1.481.85 Loratadine 10mg Tablet 1.52 1.90 Losartan (as Potassium Salt) 50mg0.740.93Losartan + Hydrochlorothiazide 50mg+ 12.5mg 4.50 5.63Losartan 100mg 3.98 4.98Losatan + Hydrochlorothiazide 100mg+ 25mg 3.50 4.38Magnesium Sulfate (as heptahydrate) 250mg/ml (IM,IV) 20ml vial 45.00 56.25 Magnesium Sulfate 25% Solution for Injection, 20ml vial 45.00 56.25 Mannitol 20% (IV) 500mL77.8397.29Mecobalamine 500mcg ampule200.00250.00Mefenamic 50mg/5ml susp35.5044.38Mefenamic Acid 500mg Capsule1.001.25Mercaptopurine 50mg Tablet21.7827.23Meropenem Trihydrate 1g powder (IM,IV) 157.88197.35Meropenem Trihydrate 500mg powder (IM,IV) 104.77130.96 Mesna 100mg/4ml Ampule 147.00 183.75 Metformin Hydrochloride 500mg film coated 1.201.50 Metfromin Hydrochloride 500mg tablet 0.53 0.66 Methimazole 5mg 5.00 6.25Methotrexate 25mg/ml (IM,IV,Intrathecal) 2mL 199.00 248.75Methyldopa 250mg 7.45 9.31Methylprednisolone 16mg 8.20 10.25 Methylprednisolone 1g vial 2,550.00 3,187.50 Methylprednisolone Siodium Succinate 1g lyophilized powder (IM,IV) 3,000.00 3750.00Methylprednisolone Siodium Succinate 500mg lyophilized powder (IM,IV) 2,300.00 2875.00Metoclopramide (as hydrochloride ) 5mg/ml (IM,IV) 2mL3.444.30 Metoclopramide 10mg Tablet 1.78 2.23 Metoclopramide 5mg/ml 2ml 3.42 4.28 Metronidazole 500mg 1.49 1.86Metronidazole 5mg/ml (IV Infusion) 100ml 13.75 17.19Midazolam 1mg/ml (IM,IV) , 5ml 59.50 74.38Midazolam 5mg/ml (IM,IV), 3mL112.22140.28Modified fluid Gelatin( For,erly polymerisate of Degraded Succinylated Gelatin) 4% solution 500mL 940.00 1175.00Montelukast 10mg 6.51 8.14Morphine (as Sulfate) 10mg 26.66 33.33Morphine (as Sulfate) 30mg 76.92 96.15Morphine* (as Sulfate) 10mg/ml (IM,IV,SC) 1ml 65.00 81.25Multivitamins for Adults 1.09 1.36Mupirocin 2% Ointment, 15g 68.00 85.00Nalbuphine Hydrochloride 10mg/ml (IM,IV,SC) 1mL54.3367.91Neostigmine ( as Methylsulfate) 500mcg/ml ( IM,IV, SC) 1mL 118.75 148.44Nepafenac eye susp. 579.00 723.75Nicardipine Hydrochloride 1mg/ml (IV), 10ml 259.00 323.75Nifedipine 10mg 3.40 4.25 Nifedipine 10mg Capsule 3.60 4.50 Nifedipine 5mg 2.98 3.73Nimodipine 30mg tablet 39.78 49.73Non-ionic Contrast 612mg/ml equiv to 300mg/ml iodine, 100mL1,182.221477.78Non-ionic Contrast 636mg/ml equiv to 300mg/ml iodine, 50mL672.33840.41Norepinephrine Bitartrate 1mg/ml (IV infusion) 2mL98.44123.05Norepinephrine Bitartrate 1mg/ml (IV infusion) 4mL189.78237.23Nystatin 100,000 units/ml Suspension, 30ml175.00218.75Ofloxacin 0.3% otic (ear) drops 5mL 180.00 225.00 Ofloxacin 0.3% otic (ear) drops 5ml Bottle 220.00 275.00 Ofloxacin 0.3% otic (ophthalmic) drops 280.00 350.00Olanzapine 10mg 5.45 6.81Omeprazole 20mg1.141.43Omeprazole 40mg20.0025.00Omeprazole 40mg powder + 10mL solvent27.4734.34Ondansetron (as hydrochloride) 2mg/ml (IM,IV) 4mL 106.67133.34Ondansetron (as Hydrochloride) 8mg 140.00 175.00Ondansetron 2mg/ml 4ml Ampule 139.85 174.81 Oral Rehydration Salts 20.5g Sachet 4.30 5.38 Oxacillin (as Sodium) 500mg Vial (IM,IV) 23.00 28.75 Oxacillin 500mg vial 17.65 22.06 Oxiplatin 2g/ml (IV Infusion) 50mL 2,688.00 3360.00Oxycodone 20mg 286.27 357.84Oxycodone HCL 10mg 170.92 213.65Oxycodone HCL 10mg/ml, 2mL 1,771.60 2214.50Oxytocin 10IU/ml ampul (IM,IV), 1mL7.899.86Paclitaxel 6mg/ml (IV,IV Infusion), 17mL 1,465.20 1831.50paclitaxel 6mg/ml (IV,IV Infusion), 5mL 985.20 1231.50Paracetamol (alcohol-free preferred) 250mg/5ml , 60ml 67.50 84.38Paracetamol 100mg/ml Drops 13.70 17.13Paracetamol 100mg/ml Drops 15ml Bottle 13.70 17.13 Paracetamol 10mg/ml , 100ml vial 124.00 155.00Paracetamol 150mg/mL (IM,IV) 2mL (AMADOL) ampule10.0012.50Paracetamol 150mg/mL (IM,IV) 2mL (FEBRINIL) ampule5.226.53Paracetamol 500mg 0.380.48Penicillin G Benzathine 1.2M iu vial49.3361.66Penicillin G Crystalline (benzylpenicillin as Sodium Salt) 1,000,000 units (IM,IV)12.4315.54Penicillin G Crystalline (benzylpenicillin as Sodium Salt) 5,000,000 units (IM,IV)16.3420.43Phenylephrine 2.5% drops457.00571.25Phenytoin (as sodium salt) 100mg capsule7.809.75Phenytoin (as Sodium Salt) 50mg/ml (IV) 2mL84.34105.43Phenytoin 100mg capsule25.0031.25 Phytomenadione 10mg/ml 1ml Ampule 12.95 16.19 Pilocarpine 2% eye drops265.00331.25Piperacillin + Tazobactam (as Sodium Salt) 2g + 250mg (IV Infusion)72.8891.10Piperacillin + Tazobactam (as Sodium Salt) 4g + 500mg (IV Infusion)93.32116.65Piperacillin + Tazobactam 4g +500mg Vial 106.00 132.50 Potassium Chloride 2meq/mL (IV Infusion) 20mL 36.50 45.63Potassium Chloride 600mg 11.00 13.75Potassium Chloride 750mg durules (as Chloride) 10meq 14.50 18.13Potassium Chloride 750mg Tablet 14.50 18.13 Potassium Citrate 10meq7.008.75Prednisone 10mg 2.10 2.63Prednisone 10mg Tablet 0.80 1.00 Prednisone 10mg/5ml Suspension, 60ml 114.00 142.50Prednisone 20mg 5.30 6.63 Prednisone 20mg Tablet 2.36 2.95 Prednisone 5mg 1.80 2.25Prednisone Acetate 1% Eye drops, 5ml 157.00196.25Propanolol 10mg 10.53 13.16Propanolol 40mg 13.60 17.00 Propofol 1% LCT 10mg/ml emulsion for Intravenous Inf. 20ml ampule 65.57 81.96 Propofol 10mg/ml (IV), 20mL 61.10 76.38Propylthiouracil 50mg tablet 8.75 10.94Propylthiouracil 50mg Tablet 10.00 12.50 Rabies Vaccine : Verocell lyophilized powder, 2.5IU/0.5ml vial+diluent (ID,IM)1,100.001375.00 Ranitidine 25mg/ml 2ml Ampule 3.18 3.98 Ranitidine Hydrochloride 150mg 0.720.90Ranitidine Hydrochloride 25mg/ml (IM,IV,IV Infusion) 2mL 3.234.04Ranitidine Hydrochloride 300mg 2.453.06Regular Insulin 150.00 187.50Rifaximin 200mg tablet 79.00 98.75Risperidone 2mg 5.67 7.09Rocuronium 10mg/mL , 5ml 192.22240.28Ropivacaine ampule 383.67 479.59Rosuvastatin (as Calcium Salt) 20mg 6.20 7.75Rosuvastatin (as Sodium Salt) 10mg3.113.89Sacubitril + Valsartan 100mg tablet56.2570.31Salbutamol Sulfate 1mg/ml (unit dose) 2.5mL 5.346.68Salbutamol Sulfate 2mg/ml (unit dose) 2.5ml 11.50 14.38Sertralin Hydrochloride 50mg 8.00 10.00Sevoflurane 250mL4,778.005972.50Silver Sulfadiazine 1% cream 20g 180.00 225.00Silver Sulfadiazine 1% cream 5g 271.74 339.68Simvastatin 20mg 2.803.50Simvastatin 40mg 3.12 3.90Sodium Bicarbonate 1 meq/ml (IV Infusion) Adult, 20ml144.32180.40Sodium Bicarbonate 650mg 1.32 1.65Sodium Bicarbonate 650mg tablet 0.99 1.24 Somatostatin 250mcg (IV,IV infusion) 798.00 997.50Somatostatin 3mg (IV,IV infusion) 5,329.00 6661.25Somatostatin 3mg vial 4,796.10 5,995.13 Spironolactone 25mg 8.35 10.44Sterile Water for injection no preservative , 50ml 35.00 43.75Streptokinase 1,500,000 IU (IV Infusion)3,638.004547.50Streptomycin vial18.0022.50Sucralfate 1g 30.0037.50Suxamethonium (Succinychloline Chloride) 20mg/ml (as chloride) , 10ml144.44180.55Tamoxifen Citrate 20mg 6.508.13Tamsulosin Hydrochloride 200mcg 38.00 47.50Telmisartan + Hydrocholorpthiazide 40mg + 12.5mg 19.23 24.04Telmisartan + Hydrocholorpthiazide 80mg + 12.5mg 34.23 42.79telmisartan 40mg 19.23 24.04Telmisartan 80mg 34.02 42.53 Telmisartan 80mg Tablet 23.21 29.01 Terbutaline Sulfate 500mcg/ml (IM,IV,SC) 1ml 96.43120.54Tetanus Toxoid (IM,IV) 0.5ml32.2240.28Timolol Maleate 0.5% Eye drops Solution, 5ml284.00355.00Tobramycin + Dexamethasone 0.3 % +0.1 % Eye drops Solution, 5ml167.00208.75Tobramycin 0.3% Eye Drops Solution, 5mL 180.00 225.00Tramadol Hydrochloride 50mg (as hydrochloride) 2.18 2.73 Tramadol Hydrochloride 50mg Capsule 2.00 2.50 Tramadol Hydrochloride 50mg/ml (IM,IV,SC) , 1ml 40.00 50.00Tramadol Hydrochloride 50mg/ml (IM,IV,SC) , 2ml 10.38 12.98Tranexamic Acid 100mg/ml (IM,IV) , 5ml14.2117.76Tranexamic Acid 500mg 5.69 7.11Trimetazidine 35mg (hydrochloride) 3.894.86Tropicamide + Phenylephrine HCl 5mg + 5mg/ml Ophthalmic Solution 10ml 665.00 831.25Ursudeoxychlolic Acid 250mg33.0041.25Valaciclovir 500mg tablet 31.61 39.51Valproate Disodium/ Valproic Acid 250mg 27.57 34.46Valproic Acid 250mg Tablet 20.00 25.00 Valsartan 160mg tablet 35.00 43.75Vancomycin Hydrochloride 500mg (IV)183.34229.18Verapamil Hydrochloride 2.5mg/ml (IV), 2mL 200.00 250.00Verapamil Hydrochloride 40mg 30.00 37.50Vinblastine Sulfate 1mg/ml , 10ml 890.321112.90Vincristine (as Sulfate ) 1mg/ml , 1ml298.00372.50Vincristine 1mg/ml (IV), 2mL 450.00 562.50 Vitamin B Complex 3ml Ampule 17.65 22.06 Vitamin B Complex B1 B6 B12 100mg + 5mg +50mcg1.702.13Vitamine B Complex : B1 B6 B12 100mg +100mg +1mg (IV), 3ml 29.98 37.48Warfarin 1mg 17.63 22.04Warfarin 2.5mg 10.00 12.50Warfarin 5mg 12.00 15.00Zinc Solution (as Sulfate Monohydrate ) solution (equiv. to20mg elemental syrup + ascorbic) , 60mL 31.79 39.74Zoldipem 10mg 31.85 39.8110. Dispensing of Medicines for OPD (Cash)The scope of pharmacy practice includes more traditional roles such as compounding and dispensing of medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information.Office or Division:Medical Devision- Pharmacy ServiceClassification:Simple TransactionType of Transaction:G2C-Government to CitizenWho may avail:All Patients CHECKLIST OF REQUIREMENTSWHERE TO SECURENo discount to be availed:Written or Electronic Prescription (completely filled) (1 original copy)Yellow prescription or Dangerous Drug Form (for prohibited or regulated) (1 original copy)Prescribing DoctorPrescribing Doctor with valid S2 LicenseWill avail discount:Written or Electronic Prescription (completely filled) (1 original copy)PWD/Senior ID and booklet (1 original copy)Authorization Letter (1 original copy) (Optional)For Gov’t Employee: Work ID and Certificate of employment ( 1 photocopy)Prescribing DoctorMunicipal/City Hall (DSWD/OSCA)Parent/GuardianEmployerCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEPresent the prescription/s and the required documents to the Pharmacist. Wait for the Charge Slip1. Checks the required documents if complete.1.1 Verifies authenticity of documents presented.1.2 Prepares corresponding charge slip1.3 Instructs the client to process the documents for verification (philhealth patient)-Proceed to MSWD for medical assistance1.4 Prepares the needs of the client.Amount will be based on the items purchased (refer to table of fees above)10 minutesPharmacistPharmacy SectionPay at the Cashier and get the Official Receipt.2. Prepares the corresponding Official Receipt.None5 minutesPharmacistPharmacy SectionReturn to the Pharmacy-Present the O.R. and get the medicine/s.3.1 Dispenses the medicine/s.3.2 Explain to the client the proper use of the medicine/s.None7 minutesPharmacistPharmacy SectionGet the medicine/s and listen to the dispensing information. Sign the prescription the return after signing4. Checks the completeness of the signed prescriptionNone1 minutePharmacistPharmacy Section Total: Amount depends on the medicines purchased (refer to table of fees above)23 minutes11. Enrollment to Point of Service ProgramIt is a Program provided by the Government Appropriation Act for the current year, to cover all Filipinos under the National Health Insurance Program (NHIP), including the unregistered and inactive registered members especially those who are financially incapable.Office or Division:Medical Division- Medical Social Work DepartmentClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREPhil health Forms (CF-1 and PMRF) (1 original copy)Attending Social WorkerSituational Requirement:Birth Certificate (1Photocopy)as needed Civil Registrar/Philippine Statistic AuthorityBaptismal Certificate (1 photocopy) ChurchGovernment Issued ID (1 photocopy)Government OfficesMarriage Contract (1photo copy) National Statistics OfficeCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Proceed to MSWD for Assessment and Classification1.Identifies patient based on assessment and classification as to Financially Incapable and Financially Capable1.2 Issuance of Phil health Form (CF1 and PMRF)None10 minutesSocial WorkerMSWD2.Submit Accomplished Phil Health Forms2. Receives Accomplished Phil Health Forms2.1 Registers to Point of Service Program for issuance of Phil health Identification Number (PIN #)2.2 Issuance of Pos-NBB StubNone10 minutesSocial WorkerMSWDReceives POS-NBB Stub3. Presents POS-NBB Stub to the Nurse Station and Attached it to patient Clinical Cover sheet once ordered May Go Home. 3.1 Submits Filled-up Phil health forms with approved Phil health Identification Number to Phil health Section for processing.None5 minutesSocial WorkerMSWDTotalNone 25 Minutes12. Emergency Room ConsultationThe Emergency Room is responsible for the provision of medical and surgical care to patients arriving at the hospital in need of immediate care.Office Division:Medical Division-Department Of Emergency MedicineClassification:Simple TransactionType of TransactionG2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECURETriage Form (1 original copy)Triage AreaEmergency Room Record Form (1 original copy)ER Admitting SectionOfficial Receipt (1 original copy) ITRMC Cost CentersSituational Requirements:Consent to Care Form (1 original copy) Consent to Ward Procedure Form (1 original copy) AlagangTagubilin Form (1 original copy)ER Nurse StationCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1.) Approach and inform ER staff on the Triage Area regarding health concerns and secure a Triage Form1.Assesses the patient’s medical needs thoroughly and will issue a triage form to the patient/ watcher/ relative and instruct the patient/ watcher/relative of the next step (whether OPD case or ER case)None5 minutesMedical Officer IV/Resident on Duty/ER Nurse/ER Nursing AttendantsEmergency Room2.) If Triaged as ER Case:2.1 Submit self for vital signs taking. (BP, CR, PR, RR, Temp, O2sat,)2.2 For Watcher/ Relatives - proceeds to admitting section for interview2.3 If Triaged as OPD Case:Proceed to the Out-Patient Department of the Hospital and approach the Triage/ Receiving Officer on duty therein2. Takes and records the patient’s Vital Signs as one of the basis of treatment on the ER Record Form provided by the Admitting Clerk on duty2.1The Admitting Clerk on duty will interview the watcher/ relative and gather information on the identity of the patient. The Admitting Clerk on duty will provide the Emergency Room Record Form of the patient concerned and instruct the watcher/ relative of the next stepThe Triage Officer will issue a Triage Form and will instruct the patient to go to the Out-Patient Department of the hospital and approach the Triage/ Receiving Officer on duty thereinNoneNoneNone6 minutes5 minutes5 minutesNurse/ Nursing Attendant/ MidwifeEmergency RoomAdmitting Clerk on Duty/ Social Worker on DutyER Medical Officer IVResident on DutyER NurseER Nursing Attendants3. Lay on the hospital bed/ waiting area and wait for your needs to be attended. The Emergency Room is NOT based on 1st come 1st serve basis, NEEDS WILL BE ATTENDED ACCORDINGLY depending on the URGENCY of your medical needs.3. The Resident on Duty of the concerned department will approach the patient and proceed with the History and Physical Examination. 3.1 All assessments and procedures done will be recorded accordingly on the ER Registry Form of the patient concernedNone10 minutesResident on DutyER NurseER Nursing AttendantER MidwivesEmergency Room4. Submit self to undergo Management and Treatment. Patient may also be subjected to other diagnostic procedures such as Laboratory, Ancillary procedures (X-ray, Ultrasound, CT-scan, etc.)4. Explains the procedures and make the patient/relative to sign the consent for Ward Treatment/ Procedure. Then the Resident Physician on Duty will attend to the patient and proceed with the management and treatment accordingly. Management and Treatment involves Medical, Surgical, and/ or Psychologic Intervention. Laboratories and other ancillary procedures may be done 4.1 Record accordingly on the ER Registry Form of the patient concerned. All assessments and procedures done will be recorded accordingly on the ER Registry Form of the patient concernedNone2 hoursResident on DutyER NurseER Nursing AttendantMidwivesEmergency Room5. PhilHealth Benefit and Eligibility Form Verification:5.1 For Philhealth Members with covered package:During the treatment process, before the disposition of the patient, the watcher/ relative will bring the patient’s Philhealth documents and will proceed to the Philhealth Portal located at the Nurse Station for verification of patient’s membership for his health benefit5.2For Non-Members:Wait for the personnel of the Social Service for the interview5. The Portal Clerk on Duty will check the validity of the member’s membership as a requirement of the Philhealth before the approval of his claim5.1 Refer the patient to the Social Service for interview for a possible grant of PhilHealth Membership for future use. NoneNone10 minutes5 minutesPortal Clerk Emergency RoomPortal Clerk / Social Worker Emergency Room6.) Disposition6.a) For Discharged PatientsWait for the disposition of the physician. Listen and remember the instructions of the doctor, and adhere to the schedule of the follow up check-up/ consultation instructed.Take the AlagangCooperate in answering the interview questions of the Social WorkerTagubilin Form and follow the home instructions written therein Take the Charge Slip from the Nurse on Duty and pay the amount indicated therein at the ER Cashier SectionUpon payment, show the official receipt to the Nurse on Duty or Security Guard on Duty before leaving the Emergency RoomThe resident on duty of the concerned department will instruct the patient on his home management regimes, prescribe medications if necessary and inform of the date of his follow up check-up. The Social Worker of the Hospital will conduct an interview to identify patients based with psychosocial assessment and classification. They will also receive referrals, provide crisis intervention to patients under VAWC, HIV, no Watcher, Trauma, HAMA and others The Resident on Duty and the Nurse on Duty will give for the AlagangTagubilin Form to the patientThe Nurse on Duty will give the patient/ watcher/ relative a Charge Slip and instruct the patient/ watcher/ relative to pay the amount at the ER Cashier Section. The Cashier Personnel on Duty will issue an Official Receipt for the payment made The Nurse on Duty or the Security Guard on Duty will check the Official Receipt as part of the hospital’s protocolNoneNoneNoneER Consultation Fee= Php. 50.00 Used Medical/Surgical Supplies=depends on the supplies/stocks used during the consultation of the patient (refer to table of fees below)None10 minutes10 minutes5 minutes10 minutes5 minutesResident Doctor on DutyEmergency RoomSocial Worker on DutyEmergency RoomResident Doctor on Duty/ Nurse on DutyEmergency RoomNurse on Duty/ Cashier Personnel on DutyEmergency RoomNurse on Duty/ Security Guard on DutyEmergency Room6.b) For Admitted Patients:Patient or watcher should sign Consent to Care Form Cooperate in answering the interview questions of the Social WorkerTransport to designated ward/unitThe Attending Physician and the ER Nurse on Duty will explain properly the situation leading to the need of admitting the patient. They will make the patient sign the Consent to Care Form. The Nurse on Duty will complete the Admission Chart prior endorsement with the receiving ward. Endorsement can be done through phone calls and/or personal endorsement with the receiving ward.The Social Worker of the Hospital will conduct an interview to identify patients based with psychosocial assessment and classification. They will also receive referrals, provide crisis intervention to patients under VAWC, HIV, no Watcher, Trauma, HAMA and others The Institutional Worker on Duty will Transport the patient to their respective ward. In cases of patients with special needs, the nurse will accompany the patient to their respective ward.NoneNoneNone20 minutes to complete the admitting chart20 minutes to complete nurses documentation10 minutes10 minutes10 minutesResident on DutyNurseResident on DutyNurseSocial Worker on DutyInstitutional WorkerTotal: Discharge: Amount depends on the procedure done (refer to table of fees below)Admitted: Automatically added to the hospital bill4 hours+ Time of any procedure doneEMERGENCY ROOM PRICE LISTFOR ORTHOPOP-………………………..?72.50WADDING SHEET- …….?47.30ELASTIC BANDAGE6”- ……………………………?30.004”- ……………………………?23.262”-…………………………….?13.26ARM SLINGSMALL- …………………….?50.38MEDIUM- …………………? 51.25LARGE- ……………………..?47.32FOR ANIMAL BITEPVRV- …………………? 1,112.50? VIAL- ……………….? 556.25ERIG ………………….? 1,500.25TRAUMAATS 1PC……………..? 84.702PCS- ………….?169.403 PCS- …………? 254.10TT – ……………………? 40.23Supply3 Way Stop Cock15.00Measuring Cup1.25Acepto Bulb19.19Neb Kit (Pedia)32.31Bt Set18.44Nebkit (Adult)36.06Cotto Pledget0.19Nasal Cannula (Neonate)31.25Cotton Balls5.00Needle Guage 253.00Gloves 6.7/7.0/7.517.00O.S.7.5Heplock11.00Packing O.S.20.00Iv Starter Pack62.50Plaster Of Paris102.38Razor Blade10.00Urine Collector2.85Wadding Sheet40.00Umbilical Clamp3.13Tegaderm (Pedia)42.35Tegaderm (Adult)60.00Urine Bag28.75MedicationsVerapamil Amp211.25Clonidine25.00Tetanus Toxoid50.00Bodesonide30.29Ats Amp90.00Amiodarone Amp606.25Mgso4118.75Ampi+Sul Vial29.07Norepinephrine400.00Captopril0.62Omeprazole Cap9.38Diphenhydramine Amp29.98Furosemide Amp87.50D5050147.00Hnbb Amp43.75Epinephrine Amp25.00Meclizine Tab11.18Hydrocortisone Vial118.75Nicardepine Amp371.50Ketorolac Amp65.99Paracetamol Amp4.61Metoclopramide Amp31.25Salbu+Ipra35.00Omeprazolw Vial106.75Sodium Bicarb Amp365.00Ranitidine Amp31.25Tramadol Amp31.25Salbutamol Plain31.25Isdn30.00Vitamin K Amp106.2513. Discharge from Oncology Unit after Outpatient Chemotherapy InfusionOncology Clinic (New ER - 2nd Floor) opens every Monday-Wednesday-Friday. Monday (8:00 – 12nn Pedia Hema-Onco), Wednesday (8:00 – 3:00 Med Onco/ Med+ Hema) and Friday (8:00 – 12nn Med Onco)Office or Division:Medical Division- Oncology UnitClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:All cancer patient undergoing chemotherapy infusion.CHECKLIST OF REQUIREMENTSWHERE TO SECUREOPD Patient Record (1 original copy)Oncology Unit Registration Accomplished Chemotherapy Protocol/ Medical Abstract (1 original copy)Resident on DutyAccomplished CF2 and CF4 (1 original copy)Resident on DutySituational Requirement:Laboratory Results (1original copy)Laboratory DepartmentMSSW Yellow Card (1 original copy)Medical Social Work Department (MSWD)PWD ID/ Senior Citizen ID (1 original copy)Medical Social Work Department (MSWD)CLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Ask for Documents Facilitates the documents.None10 minutesNurse I/ Nurse IIOncology Unit2. Submit all the requirements.2. Checks for the completeness of requirements.2.1 Provides patient and watcher a copy of requirements.None10 minutesNurse I/Nurse IIOncology Unit3. Proceed to PhilHealth Portal or Medical Social Service3. Instructs patient and watcher to proceed at PhilHealth Portal for claims or MSS/ Malasakit Center for assistance.None30 minutesPhilHealth Staff/ Social WorkerMalasakit Center4. Return to Oncology Unit4. Provides health education on patient and watcher.4.1 Assists patient for discharge.None10 minutesNurse I/ Nurse IIOncology UnitTotal:None1 hour13. OPD Physical TherapyRehabilitation Medicine is recovery medicine with the aim of restoring physical function and improving the quality of life of our patients. Our specialty encompasses developmental medicine to geriatric medicine, focusing on neuromuscular and musculoskeletal disorders including pain management. Office or Division:Medical Division- Department of Rehabilitation MedicineClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:All who may want to avail the serviceCHECKLIST OF REQUIREMENTSWHERE TO SECUREOut Patient Department Record/Blotter Form (1 original copy)OPDSituational Requirements: Interdepartmental Referral Form (1 original copy)OPDReferral Form/Letter (1 original copy)OPD/other hospitals or clinicsPWD/Senior Citizen ID (1original copy)Respective municipalityYellow Card (1 original copy)Medical Social Worker ServicePhilhealth MDR (1 original copy)Philhealth OfficeConsent Form for Rehabilitation Services Procedure (1 original copy)Dept. of Rehab. Med.OPD On-line Consult Schedule/Confirmation(Thru SMS)ITRMC Online Konsulta Web PortalOPD Screening Form ( 1 original copy)Dept. of Rehab MedicineCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEPresent the OPD Record and/or Referral Form/Interdepartmental Referral Form/Online Consultation Schedule or ConfirmationAsk for OPD Record and/or referral form/letter /On line Consult Schedule/ConfirmationNone2 minutesPhysical TherapistRehabilitation Medicine2.Shall submit to the following procedures:thermal scanningfill up contact tracing logbookanswer OPD Screening Form2.Dos triaging/screening for COVID-19None3 minutesPhysical TherapistRehabilitation MedicineFill –up the Consent form for Rehabilitation Medicine Procedures3.Gives consent Form to patient, explain the procedure and guide the patient in filling up the form.None3 minutesPhysical TherapistRehabilitation MedicineSubject to doctor’s evaluation4.Perform evaluation4.1. New patients/follow-up patients: Do history and physical examination 4.2.Old patients continuing PT treatment proceed to step 5None30 minutes consult timePhysicianRehabilitation MedicineReceive the charge slip and check or verify the completeness of the details5. Issue charge slip and instruct patient to pay at the Cashier 5.1 NBB (No Balance Billing) patients, proceed to step 5 upon presentation of valid I.D.(SC or PWD) and/or MDR5.2 Patients who are unable to pay the required amount are referred to Medical Social Service for classification5.3 All ITRMC employees and their dependents, proceed to step 5 upon acknowledgement of charge (signing their charge slips)5.4 All stakeholders or government officials who wish to avail discount or free service are mandated for classification and assessment by the medical social service and will be issued with Yellow CardRefer to posted price list10 minutesPhysical TherapistRehabilitation Medicine6. Present OR to the Administrative Assistant/ Physical Therapist6. Record OR number (Official Receipt)None2 minutesPhysical TherapistRehabilitation Medicine7. Subject to Physical Therapy treatment7. Carries Out Physical Therapy treatment program as prescribed by the physiatrist.None 90 minutesPhysical TherapistRehabilitation Medicine8. Get next schedule and know the instructions from the physical therapist8. Gives next treatment schedule and further instructions to the patientNone 3 minutesPhysical TherapistRehabilitation MedicineTotal:Amount may depend on the availed service (refer to table of fees below)2 hours and 23 minutesPHYSICAL THERAPY SERVICES COSTINGAs Approved by the ITRMC Costing Committee last 2019General Instruction Exercise ?250.00Conventional Program for 1 General Area ?325.00Conventional Program for 2 General Areas?400.00Conventional Program for 3 General Areas?500.00Conventional Program for 4 General Areas?600.001 New Equipment for 1 General Area (using Extremity Pump Intermittent Compression Unit)?275.001 New Equipment + Conventional Program for 1 General Area (Using Extremity Pump Intermittent Compression Unit)?350.001 New Equipment for 1 General Area (using new equipment other than Extremity Pump Compression Unit) ?375.001 New Equipment + Conventional Program for 1 General Area (using new equipment other than Extremity Pump Compression Unit)?450.002 New Equipment for 1 or More General Areas?500.002 New Equipment + Conventional Program for 1 or More General Areas?600.003 New Equipment for 1 or More General Areas?700.003 New Equipment + Conventional Program for 1 or More General Areas?800.00Office or Division:Medical Division-Medical Social Work DepartmentClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREStatement of Account/Charge Slip (1 original copy)Phil health/Billing Sections (Pharmacy, Radiology, Laboratory, Dental, Emergency and Out Patient Department)Patient Information Sheet (1 original copy)Malasakit CenterUnified Intake Sheet (1 original copy)Malasakit CenterMedical Abstract (1 original copy)Attending PhysicianGuarantee Letter (1 original copy)Legislators/DSWD/LGUCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Present the Documents and statements of Account/Charge Slip for evaluation1. Recieves and Checks documents presented.1.1 Issues Patient Information Sheet to be filled up.None3 minutesSocial WorkerMSWD2. Accomplish Patient Information Sheet to be submitted to participating agencies.2. Refers clients to relevant participating agencies2.1 Participating agency assesses the client accomplishes the Unified Intake Sheet.2.2 Approval of Medical Assistance None10 minutesPhilHealth/ PCSO/DSWD/ DOH-MAIP Representative3. Proceed to the Cost Centers for proper settlement of bills and secure clearance for discharge3. Instructs to procced Cost Centers for proper settlement of bills.None2 minutesSocial WorkerMSWDTotal: None15 minutes15. Malasakit CenterOne-Stop-Shop for medical and financial assistance provided by the following agencies/facilities; Phil health, PCSO, DSWD, DOH, Host Hospital and the LGU.16. Outpatient Chemotherapy InfusionOncology Clinic (New ER - 2nd Floor) opens every Monday-Wednesday-Friday.Monday (8:00 – 12nn Pedia Hema-Onco), Wednesday (8:00 – 3:00 Med Onco/ Med Hema) and Friday (8:00 – 12nn Med Onco)Office or Division:Medical Division-Oncology UnitClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:All cancer patient requiring administration of chemotherapy.CHECKLIST OF REQUIREMENTSWHERE TO SECUREOPD Patient Record (1 original copy)Oncology Unit Registration Chemotherapy Protocol (1 original copy)Oncology ClinicLaboratory results (1 original copy)Laboratory DepartmentPrescription ( 1 original copy)PhysicianConsent for procedure (1 original copy)Oncology ClinicCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit requirements for chemotherapy.Verifies the patient information and doctor’s order.1.1 Explains the procedure to patient and watcher. 1.2 Instructs watcher to proceed to pharmacy for the retrieval of prescribed medications.None30 minutesNurse I/Nurse IIOncology Unit2.Read and sign the consent for chemotherapy.Secures consent for the procedure.2.1 Takes patient vital signs Immediately before administration2.2 Queues patient for the procedure.2.3 Instructs patient to wait until name is called and enter the infusion room once called.None20 minutesNurse I/Nurse IIOncology Unit3. Chemotherapy Administration. 3. Aseptically prepares and mixes the chemotherapy drugs.3.1 Aseptically hooks patient to intravenous fluid.3.2 Administers pre-medication and intravenous hydration prior to chemotherapy if needed.3.3 Administers the prescribed chemotherapy drugs.None3 HoursNurse I/Nurse IIOncology Unit4. Complete the chemotherapy Regimen. 4. Monitors patient for any early and late chemotherapy adverse reaction.4.1 Provides health education on home medications and delayed reactions and instruct their appropriate interventions.4.2 Instructs patient for the next cycle and secure laboratory test if necessary.None15 minutesNurse I/Nurse IIOncology UnitTotal None4 hours and 5 minutes17. Outpatient Cancer and Hematology ConsultationOncology Clinic (New ER - 2nd Floor) opens every Monday-Wednesday-Friday. Monday (8:00 – 12nn Pedia Hema-Onco), Wednesday (8:00 – 3:00 Med Onco/ Med Hema) and Friday (8:00 – 12nn Med Onco)Office or Division:Medical Division- Oncology UnitClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:All cancer patient requiring Medical Oncology and Hematology Consultation including patient undergoing chemotherapy.CHECKLIST OF REQUIREMENTSWHERE TO SECUREPrescription (1 original copy)PhysicianAccomplished Patient Personal profile (1 original copy)Oncology Unit RegistrationPatient Record (1 original copy)Outpatient Department Record Section – Window 9Health Declaration form (1 original copy)Triage 1Situational Requirements: Diagnostic Test/Imaging Results (1 original copy)Laboratory Department/Radiology DepartmentBlue card/Yellow card (1 original copy)Social Service/OPD RegistrationCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubject self for interview at the triage 1.Interviews patient regarding purpose of visiting the clinic.Interviews patient for any travel history or any signs and symptoms related to COVID-19.Provides patient a declaration form and navigate patient.None3 minutesTriage OfficerDRMMHPresent yellow card/blue card or fully accomplished patient personal profile.Instructs patient or watcher to write the patient information on patient personal profile slip or ask for yellow card/blue card.Receives, verifies and checks the completeness and accuracy of information.Encodes/ registers the patient information to HOMIS.Prepares and retrieves Patient Record for consultation.None30 minutesAdministrative OfficerMSWD Proceed to Vital Signs Taking Area and wait for consultation.Records patient vital signs to patient record.3.1 Queues patient for consultation.3.2 Instructs patient and watcher to wait until the name is called and enter the clinic once name is called.None2 hoursNurse/Nursing AttendantOncology Unit4. Consult with the Physician.3. Conducts thorough history taking and perform physical examination if needed.3.1 Explains the findings, management and plans for the patient.3.2 Gives prescription, diagnostic request and referral if necessary. 3.3 Ask patient for any concerns, health educates on home medication and instruct patient for the next follow-up visit.None30 minutesMedical Specialist/ Medical OfficerOncology UnitTotal:None3 hours and 3 minutes18. Out Patient Dental RadiographyThe Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:All dental patientCHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianOfficial Receipt (1 original copy)Billing and Cashier SectionCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on dutyNone5 minutesRadiologic TechnologistRadiology DepartmentIssuance of charge slip2. Gets the charge slip and proceed to cashier section for payments or Medical Social Service for financial assistance.Panoramic- 800.00/ Cephamlometric- 800.003 minutesRadiologic TechnologistRadiology DepartmentPresent the official receipt3. Receives your official receipt and wait for your name to be calledNone10 minutesRadiologic TechnologistRadiology DepartmentActual Examination4. Radiologic Technologist on duty will perform the requested examination.*Instruct patient to go back to their requesting physician for evaluation and management after the examinationNone15 minutesRadiology ResidentRadiology DepartmentReleasing of official results for ENT and Surgery patients/Printed images for Dental Patients5. Presents your official receiptNone15 minutesRadiologic TechnologistRadiology DepartmentTotal:P 800.0048 minutes19. Out Patient Magnetic Resonance Imaging (MRI)The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Complex TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:All CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianOfficial Receipt (1 original copy)Billing and Cashier SectionClaim Slip (1 original copy)Radiology DepartmentLaboratory Result (Creatinine) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on duty for routine MRI and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Gets the charge slip and proceed to cashier section for payments or Medical Social Service for financial assistance.Note: Contrast is not included in the priceAmount will be based on the availed procedure3 minutesRadiologic TechnologistRadiology DepartmentPresent the official receipt3. Receives official receipt and wait for your name to be calledNone10 minutesPatient/Relative/WatcherActual Examination4. Radiologic Technologist on duty will perform the requested examination.4.1 Instructs patient to go back to their requesting physician for evaluation and management after the examinationNone(time of procedure may vary depending on the type)Radiologic Technologist/ Radiology ResidentsRadiology DepartmentReleasing of official results 5. Present your official receipt and claim slip at the reception areaNone72 hoursRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the procedure availed (refer to table of fees below)72 hours, 18 minutes+ time depending the procedure availed (refer to table below)RADIOLOGY DEPARTMENT PROCEDURAL TIMECranial Orbits Temporal BoneParanasal SinusesOral Cavity Mandible Neck Chest High Resolution Chest Upper AbdomenTriphasic Scan of the Liver Lower Abdomen Whole Abdomen Triphasic/Dynami10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes15 minutes30 minutes30 minutes30 minutes30 minutes30 minutesc Scan Whole Abdomen StonogramPelvic Cervical Spine Thoracic Spine Lumbar SpineUpper Extremity Lower Extremity Brain Angiogram Upper Extremity AngiogramLower Extremity Angiogram Guided Biopsy 15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes30 minutes30 minutes30 minutes60 minutesPRICELIST ON MRIBrain MRI - 7,000.00Brain MRA - 7,900.00Brain MRI + MRA - 11,920.00Brain MRI + MRV – 11,920.00Brain MRI + MRA + MRV – 18,920.00Brain MRS – 27,000.00Sella Turcica – 10,700.00Orbits – 7,500.00Paranasal Sinuses – 10,700.00Internal Auditory Canal – 10,700.00Brachial Plexus – 6,550.00Chest – 6,550.00Breasts – 9,800.00Shoulder – 6,550.00Forearm/Arm – 6,550.00Hand/Wrist – 6,550.00Pelvis – 6,550.00Femur/Leg – 6,550.00Foot/Ankle – 6,550.00Knee – 6,550.00Upper Abdomen – 9,000.00Lower Abdomen – 9,000.00Whole Abdomen – 14,000.00MRCP- 13,500.00Whole Abdomen + MRCP – 27,000.00Cervical Spine – 6,550.00Thoracic Spine – 6,550.00Lumbar Spine – 6,550.00Cervico-Thoracic – 13,500.00Thoraco-Lumbar- 13,500.00Whole Spine – 19,650.00Hip (Unilateral) – 6,550.0020. Out Patient UltrasoundThe Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianOfficial Receipt (1 original copy)Billing and Cashier SectionClaim Slip (1 original copy)Radiology DepartmentLaboratory Result (CTBT,Platelet) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on duty for routine Ultrasound and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Gets the charge slip and proceed to cashier section for payments or Medical Social Service for financial assistance.Amount will be based on the procedure availed (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentPresent the official receipt3. Presents your official receipt and wait for your name to be calledNone10 minutesRadiologic TechnologistRadiology DepartmentActual Examination4. Radiologic Technologist on duty will perform the requested examination.*Instruct patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table below for the procedural timeRadiologic Technologist/ Radiology ResidentsRadiology DepartmentReleasing of official results Presents your official receipt and claim slip at the reception areaNone24 hoursRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the procedure availed (refer to table of fees) below1 day and 18 minutes+ time of the procedure availed (refer to table of procedural time below)RADIOLOGY DEPARTMENT PROCEDURAL TIMEThyroid/NeckChest/Hemithorax Whole Abdomen Abdomen + Pelvic Abdomen + Prostate Upper Abdomen HBT Pancreas/Spleen Liver HBT + Kidneys HBT + Pancreas HBT + Abdominal Aorta HBT + Kidneys + Spleen HBT + Pelvic Gallbladder Kidneys Abdominal Aorta Urinary BladderPelvic Prostate Scrotal/Testicular/Inguinal Biophysical Scoring (BPS) KUB KUB-Prostate Cranial Cardiac Breasts Transvaginal Section (TVS) Transrectal Section (TRS) Fetal Biometry Emergency Ultrasound (E-Fast) Soft Tissue Biopsy Ultrasound Use (For Biopsy/Catheter Insertion) 20 minutes15 minutes30 minutes30 minutes30 minutes20 minutes15 minutes15 minutes10 minutes20 minutes15 minutes20 minutes30 minutes20 minutes15 minutes20 minutes15 minutes15 minutes20 minutes15 minutes20 minutes 30 minutes20 minutes20 minutes15 minutes20 minutes30 minutes15 minutes15 minutes30 minutes15 minutes15 minutes30 minutes30 minutesPRICE LIST ON ULTRASOUNDThyroid/Neck – 450.00Chest/Hemithorax – 450.00Whole Abdomen – 500.00Abdomen + Pelvic – 550.00Abdomen + Prostate – 500.00Upper Abdomen – 400.00HBT – 300.00Pancreas/Spleen – 300.00Liver – 300.00HBT + Kidneys – 350.00HBT + Pancreas – 350.00HBT + Abdominal Aorta – 350.00HBT + Kidneys + Spleen – 450.00HBT + Pelvic – 350.00Gallbladder – 300.00Kidneys – 300.00Abdominal Aorta – 300.00Urinary Bladder – 300.00Pelvic – 300.00Prostate – 300.00Scrotal/Testicular/Inguinal – 450.00Biophysical Scoring (BPS) – 500.00KUB – 400.00KUB-Prostate – 450.00Cranial – 450.00Cardiac – 450.00Breasts – 450.00Transvaginal Section (TVS) – 450.00Transrectal Section (TRS) – 450.00Fetal Biometry – 450.00Emergency Ultrasound (E-Fast) – 500.00Soft Tissue – 450.00Biopsy – 500.00Ultrasound Use (For Biopsy/Catheter Insertion) – 500.0021. Out Patient X-RayThe Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division-Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2G- Government to Government/ G2B- Government to BusinessWho may avail:All CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianOfficial Receipt (1 original copy)Billing and Cashier SectionClaim Slip (1 original copy)Radiology DepartmentLaboratory Result (Creatinine) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on duty for routine X-rays and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Gets the charge slip and proceed to cashier section for payments or Medical Social Service for financial assistance.Amount will be based on the procedure availed (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentPresent the official receipt3/ Present your official receipt and wait for your name to be calledNone 10 minutesRadiologic TechnologistRadiology DepartmentActual Examination4. Radiologic Technologist on duty will perform the requested examination.4.1 Instruct patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table of procedural time belowRadiologic Technologist/Radiology ResidentRadiology DepartmentReleasing of official resultsPresent your official receipt with claim slip at the reception areaNone24 hoursRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the availed procedure (refer to table of fees below)1 day, 18 minutes+ time of the availed procedure (refer to table of procedural time below)RADIOLOGY DEPARTMENTPROCEDURAL TIMEAbdomen APL- (Pedia) Abdomen DecubitusAnkle (Mortise View)Ankle APAnkle APLAnkle APL/Mortise ViewArm APArm APLAxillary ViewBabygramCalcaneal ViewCanale ViewCervical APLCervical Spine LateralCervical Spine Right and Left ObliquesCervicothoracic Spine APLChest AP/PA AdultChest PAL (Adult)Chest APL (Pedia) Chest Right/Left Lateral DecubitusClavicle APCoccyx APLElbow APLFemur APFemur APLFetogramAbdomen Supine and UprightFoot APL/ObliqueFoot APOLForearm AP15 minutes10 minutes10 minutes10 minutes15 minutes15 minutes10 minutes15 minutes10 minutes15minutes10 minutes10 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes10 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes10 minutesForearm APLGreenspan ViewHand APOHand APOLHip Joint APHumerus APInvertogramJones ViewKnee (Skyline View)Knee (Sunrise View)Knee Joint APLKnee Joint APOLLeg APLeg APLLumbosacral Right and Left ObliquesLumbosacral APLMandible APOMastoid SeriesNasal Bone LateralParanasal SinusesPelvis (Frogleg)Pelvis (Iliac View)Pelvis (Inlet)Pelvis (Outlet)Pelvis (Obturator View)Pelvis APPelvis APLPlain Abdomen APPlain KUBSacrum APLScaphoid SeriesScapular Y ViewSerendipity ViewShoulder APShoulder Joint Trauma SeriesSkull AP onlySkull APLSkull APL/Towne’sSkull Caldwell’s ViewSkull-Tangential ViewSkull Towne’s ViewSkull Water’sSoft Tissue Neck LateralSubmento-Vertical ProjectionTemporo Mandibular Joint APOThoracic CageThoracic Spine APLThoraco-Lumbar Spine APLWrist APLZanca ViewSpecial Procedure:ArteriogramBarium EnemaBarium SwallowCardiac SeriesColonogramCystogramCystourethrogramFistulogramHysterosalphingogramIntravenous PyelogramSialogramSinugramSkeletal SurveySmall Intestinal SeriesT-tube CholangiogramTube NephrogramUpper Gastro Intestinal SeriesUrethrogram15 minutes15 minutes10 minutes10 minutes15 minutes10 minutes10 minutes10 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes10 minutes10 minutes15 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes10 minutes15 minutes15 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes10 minutes15 minutes15 minutes10 minutes10 minutes60 minutes90 minutes45 minutes90 minutes90 minutes30 minutes45 minutes45 minutes45 minutes90 minutes45 minutes45 minutes30 minutes60 minutes30 minutes90 minutes45 minutes45 minutesPRICE LIST ON X-RAYRoutine:Abdomen AP (Adult/Pedia) Portable- 200.00Abdomen APL (Portable)-400.00Chest AP Portbale- 200.00Chest APL Pedia (Portable)- 300.00Pelvis AP Portable- 200.00Abdomen APL- (Pedia) 200.00Abdomen Decubitus- 150.00Ankle (Mortise View)- 150.00Ankle AP- 150.00Ankle APL- 150.00Ankle APL/Mortise View- 250.00Arm ap- 150.00Arm APL- 200.00Axillary View- 150.00Babygram- 200.00Calcaneal View- 150.00Canale View- 150.00Cervical APL- 200.00Cervical Spine Lateral- 100.00Cervical Spine Right and Left Obliques- 250.00Cervicothoracic Spine APL- 550.00Chest AP/PA Adult- 150.00Chest PAL (Adult)- 300.00Chest APL (Pedia)- 200.00Chest Right/Left Lateral Decubitus- 150.00Clavicle AP-150.00Coccyx APL- 250.00Elbow APL-150.00Femur AP- 150.00Femur APL- 300.00Fetogram- 150.00Abdomen Supine and Upright- 300.00Foot APL/Oblique-150.00Foot APOL- 250.00Forearm Ap-150.00Forearm APL- 200.00Greenspan View- 150.00Hand APO-150.00Hand APOL-250.00Hip Joint AP- 150.00Humerus AP-150.00Invertogram- 300.00Jones View-150.00Knee (Skyline View)- 150.00Knee (Sunrise View)- 150.00Knee Joint APL- 150.00Knee Joint APOL- 250.00Leg AP- 150.00Leg APL-300.00Lumbosacral Right and Left Obliques- 250.00Lumbosacral APL- 250.00Mandible APO- 200.00Mastoid Series- 300.00Nasal Bone Lateral- 100.00Paranasal Sinuses- 150.00Pelvis (Frogleg)- 150.00Pelvis (Iliac View)- 150.00Pelvis (Inlet)- 150.00Pelvis (Outlet)- 150.00Pelvis (Obturator View)- 150.00Pelvis AP- 150.00Pelvis APL-300.00Plain Abdomen AP- 150.00Plain KUB- 150.00Sacrum APL- 250.00Scaphoid Series- 300.00Scapular Y View- 150.00Serendipity View- 150.00Shoulder AP- 150.00Shoulder Joint Trauma Series- 450.00Skull AP only- 100.00Skull APL- 200.00Skull APL/Towne’s- 300.00Skull Caldwell’s View- 100.00Skull-Tangential View- 100.00Skull Towne’s View- 100.00Skull Water’s- 100.00Soft Tissue Neck Lateral- 100Submento-Vertical Projection- 100.00Temporo Mandibular Joint APO- 200.00Thoracic Cage- 150.00Thoracic Spine APL-250.00Thoraco-Lumbar Spine APL- 550.00Wrist APL- 150.00Zanca View- 150.00Special Procedure:Close Reduction (Long bone-OR)- 600.00Close Reduction (Short bone-OR)- 500.00Intra-operative Cholangiogram- 1,500.00Retrograde Pyelogram- 900.00Arteriogram- 700.00Barium Enema- 1,200.00Barium Swallow-850.00Cardiac Series- 800.00Colonogram- 1,200.00Cystogram- 800.00Cystourethrogram- 1,500Fistulogram- 1,400.00Hysterosalphingogram-1,400.00Intravenous Pyelogram- 900.00Sialogram- 900.00Sinugram- 700.00Skeletal Survey-2,000.00Small Intestinal Series-850.00T-tube Cholangiogram- 800.00Tube Nephrogram- 900.0022. Out Patient CT Scan The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division-Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/ G2G- Government to Government/G2B- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianOfficial Receipt (1original copy)Billing and Cashier SectionClaim Slip (1 original copy)Radiology DepartmentLaboratory Result (Creatinine) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on duty for routine CT Scan and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Gets the charge slip and proceed to cashier section for payments or Medical Social Service for financial assistance.Note: Contrast is not included in the priceAmount will be based on the availed procedure (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentPresent the official receipt3. Receive your official receipt and wait for your name to be calledNone 10 minutesRadiologic TechnologistRadiology DepartmentActual Examination4. Perform the requested examination.4.1 Instruct patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table of procedural time belowRadiologic Technologist/Radiology Resident Radiology DepartmentReleasing of official results 5. Present your official receipt and claim slip at the reception areaNone48 hoursRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the availed procedure (refer to table of fees below)2 days and 18 minutes+ time of the availed procedure (refer to table of procedural time below)RADIOLOGY DEPARTMENTPROCEDURAL TIMECranial Orbits Temporal BoneParanasal SinusesOral Cavity Mandible Neck Chest High Resolution Chest Upper AbdomenTriphasic Scan of the Liver Lower Abdomen Whole Abdomen Triphasic/Dynamic Scan Whole Abdomen StonogramPelvic Cervical Spine Thoracic Spine Lumbar SpineUpper Extremity Lower Extremity Brain Angiogram Upper Extremity AngiogramLower Extremity Angiogram Guided Biopsy 10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes15 minutes30 minutes30 minutes30 minutes30 minutes30 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes30 minutes30 minutes30 minutes60 minutesPRICE LIST ON CT SCANCranial – 2,500.00Orbits – 3,000.00Temporal Bone – 3,000.00Paranasal Sinuses – 3,000.00Oral Cavity – 3,000.00Mandible – 3,000.00Neck – 3,000.00Chest – 3,000.00High Resolution Chest – 7,000.00Upper Abdomen – 3,000.00Triphasic Scan of the Liver – 8,000.00Lower Abdomen – 3,000.00Whole Abdomen – 5,100.00Triphasic/Dynamic Scan Whole Abdomen – 10,000.00Stonogram – 3,000.00Pelvic – 3,000.00Cervical Spine – 3,200.00Thoracic Spine – 3,200.00Lumbar Spine – 3, 200.00Upper Extremity – 3,200.00Lower Extremity – 3, 200.00Brain Angiogram – 8,000.00Upper Extremity Angiogram – 15,000.00Lower Extremity Angiogram – 15,000.00Guided Biopsy – 2,500.0023. Request for Medical Certificate / Confinement Certificate Medical Certificate is issued when the patient is already discharged, whereas, the Confinement Certificate is issued when the patient is still confined in the hospital. These certificates should be a controlled document and must be pre-numbered.Office or Division:Medical Division-Health Information Management DepartmentClassificationSimple TransactionType of Transaction:G2G – Government to CitizenWho may avail:Patients or the nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREValid ID as competent proof of identity (1 original copy)Office/Department concernedSituational Requirement:Authorization Letter (1 original copy)Client CLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Fill out the Request Slip Form and check the requested type of document. Get a transaction number and wait to be called.1. Calls client according to transaction numberNone1 minuteHIMD StaffHIMD2. Present to the HIMD Staff the Request Slip Form and the necessary requirements.2. Receives Request Slip2.1. Interviews the requesting person and validate the submitted requirements.2.2. Retrieval of Records for preparation of the Certificate.None Retrieval of Record: present (one day) ; 2017-2019 (1-2 days) ; 2011-2016 (3-5 working days) ; 2008-2010 (5-7 days) ; 2005-2007 (two weeks)HIMD StaffHIMD3. Preparation of the Medical Certificate/Confinement Certificate. 3. Prepares the Medical Certificate or the Confinement Certificate requested.None 10 minutesHIMD StaffHIMD4. Proceed to the Cashier to pay the required amount.4. Receive payment and issue official receipt100.0015 minutesHIMD StaffHIMD5. Proceed to the HIMD Main Records Section and present the official receipt.Receive the official receipt. Release the requested certificate with the official dry seal of the hospital.None15 minutesHIMD StaffHIMDTotal:100.0041 minutes+ time of retrieval of record based on year requested24. Request for Death Certificate (Non- COVID)Death Certificate is permanent disappearance of all evidence of life at any time after live birth has taken place. This certificate shall be released only to the legal heirs or the nearest kin available.Office or Division:Medical Division-Health Information Management DepartmentClassificationSimple TransactionType of Transaction:G2G – Government to CitizenWho may avail:Nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREValid ID as competent proof of identity (1 original copy)Office/Department concernedSituational Requirement:Authorization Letter (1 original copy)Nearest Relative of the DeceasedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Fill out the Request Slip Form and check the requested type of document. Get a transaction number and wait to be called.1. Calls client according to transaction numberNone 1 minuteHIMD StaffHIMD2. Present to the HIMD Staff the Request Slip Form and the necessary requirements.2. Receives Request Slip2.1. Interviews the requesting person and validate the submitted requirements.None 10 minutesHIMD StaffHIMD3. Preparation of the Death Certificate. 3. Prepares the Death Certificate None 10 minutesHIMD StaffHIMD4. Proceed to the Cashier for the Clearance or the Official Receipt.4. Receives payment and issues official receiptNone 15 minutesHIMD StaffHIMD5. Proceed to the HIMD Main Records Section and present the official receipt/clearance.5. Receive the official receipt. Release the Death Certification for registration at the Local Civil Registrar.None15 minutesHIMD StaffHIMDTotalNone51 minutes25. Request for Death Certificate (COVID)Death Certificate is permanent disappearance of all evidence of life at any time after live birth has taken place. This certificate shall be released only to the legal heirs or the nearest kin available.Office or Division:Medical Division-Health Information Management DepartmentClassificationSimple TransactionType of Transaction:G2G – Government to CitizenWho may avail:Nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREValid ID as competent proof of identity (1original copy)Office/Department concernedSituational Requirement:Authorization Letter (1 original copy)Nearest Relative of the DeceasedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Receive copy of the patient’s death certificate upon furnishing the required information in the death certificate form and presentment of a valid ID as competent proof of identity.and wait to be called.1. Calls client according to transaction number1.1. Receives Request Slip1.2. Interviews the requesting person and validate the submitted requirements.None 60 minutesHIMD StaffHIMD2. Receive advise on claiming the original copy at the Local Civil Registrar after 1 week after death1. Prepares the Death Certificate 1.1Releases the Death Certification through email for registration at the Local Civil Registrar.None 5 minutes HIMD StaffHIMDTotalNone65 minutes26. Request for Medico Legal Certificate / Violet RibbonMedico-Legal Certificate shall be duly signed by the Attending Physician/Medical Center Chief/Medico-Legal Officer and release with the official dry seal.Office or Division:Medical Division-Health Information Management DepartmentClassificationSimple TransactionType of Transaction:G2G – Government to CitizenWho may avail:Patient/Nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREValid ID as competent proof of identity (1 original copy)Office/Department concernedSituational Requirement:Authorization Letter (1 original copy)Nearest Relative of the DeceasedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Fill out the Request Slip Form and check the requested type of document. Get a transaction number and wait to be called.1. Calls client according to transaction numberNone 1 minuteHIMD StaffHIMD2. Present to the HIMD Staff the Request Slip Form and the necessary requirements.2. Receives Request Slip2.1. Interviews the requesting person and validate the submitted requirements.None 10 minutesHIMD StaffHIMD3. Preparation of the Medico-Legal Certificate.3. Prepares the Medico-Legal Certificate requested.None10 minutesHIMD StaffHIMD4. Proceed to the Cashier for the Clearance or the Official Receipt.4. Receives payment and issues official receipt100.0015 minutesCashier StaffCash Section5. Proceed to the HIMD Main Records Section and present the official receipt.5. Receives the official receipt. Releases of requested documentNone15 minutesHIMD StaffHIMDTotal:100.0051 minutes27. Request for Certified True Copies of Hospital Health RecordsCertified Photocopies of patients’ health records may be released but not limited to the following: Discharge Summary/Clinical Abstract, Office or Division:Medical Division- Health Information Management DepartmentClassificationSimple TransactionType of Transaction:G2G – Government to CitizenWho may avail:Patient/Nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREValid ID as competent proof of identity (1 original copy)Office/Department concernedSituational Requirement:Authorization Letter (1 original copy)Nearest Relative of the DeceasedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Fill out the Request Slip Form and check the requested type of document. Get a transaction number and wait to be called.1. Calls client according to transaction numberNone 1 minuteHIMD StaffHIMD2. Present to the HIMD Staff the Request Slip Form and the necessary requirements.2. Receives Request Slip2.1. Interviews the requesting person and validate the submitted requirements.None 10 minutesHIMD StaffHIMD3. Photocopying and Certifying the requested health records.3. Photocopies and certifies the health records requested.NoneRetrieval of Record: present (one day) ; 2017-2019 (1-2 days) ; 2011-2016 (3-5 working days) ; 2008-2010 (5-7 days) ; 2005-2007 (two weeks) HIMD StaffHIMD4. Proceed to the Cashier for the Clearance or the Official Receipt.4. Receives payment and issues official receipt2.50/page15 minutesHIMD StaffHIMD5. Proceed to the HIMD Main Records Section and present the official receipt.5. Receives the official receipt. Release the Certified True Copies of Health Records with the official dry seal.N/A15 minutesHIMD StaffHIMDTotal:Amount will be based on number of pages(2.50/page)41 minutes+ time of retrieval based on the year being requested28. Request for Birth Certificate ClearanceAccomplishment of the Certificate of Live Birth shall be in accordance with the instruction manual: Civil Registry Administrative Book No. 1, series of 1193 (Implementing Rules and Regulations of the Republic Act No. 3753 and other laws on Civil Registration).Office or Division:Medical Division- Health Information Management DepartmentClassificationSimple Transaction Type of Transaction:G2G – Government to CitizenWho may avail:Patient or the nearest relative within the 4th degree of consanguinityCHECKLIST OF REQUIREMENTSWHERE TO SECUREParents’ valid ID as competent proof of identity (1original copy)Authorization Letter ( Situational Requirement) (1 original copy)Birth Certificates of Parents (if there are Irregularities in the ID)(1 original copy)For Late Registration:Any of the following:PSA Negative Certification (1 original copy)Affidavit to Use the Surname of the Father (1 original copy)School ID and Records of the Child (1 photocopy)Affidavit of Two Disinterested Persons (1 original copy)Marriage Contract (1 photocopy)Medical Certificate (1 photocopy)Office/Department concernedCLIENT STEPSAGENCY ACTIONFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Fill out the Request Slip Form and check the requested type of document. Get a transaction number and wait to be called.1. Calls client according to transaction numberNone 1 minuteHIMD StaffHIMD2. Present to the HIMD Staff the Request Slip Form and the necessary requirements.2. Receives Request Slip2.1. Interviews the requesting person and validate the submitted requirements.None 10 minutesHIMD StaffHIMD3. Proceed to the Cashier to pay the required amount.3. Receives payment and issues official receipt200.00 – Affidavit to Use the Surname of the Father400.00 – Late Registration15 minutesHIMD StaffHIMD4. Proceed to the HIMD Main Records Section and present the official receipt.4 . Receives the official receipt and releasing of Birth Certificate Clearance.None 15 minutesHIMD StaffHIMDTotal:200.00 – Affidavit to Use the Surname of the Father400.00 – Late Registration51 minutes29. Special Case Management AssistanceIt is the collaborative process of assessment, planning and facilitation for options and services to meet an individual’s complex needs. It includes arranging, coordinating, monitoring, evaluating, and advocating on behalf of the client and his/her family for the multiple services that are needed by the client.Office or Division:Medical Division- Medical Social Work DepartmentClassification:Simple TransactionType of Transaction:G2C – Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREInterdepartmental Referral Form/MSWD Referral Form (1 original copy)ER, OPD and WardCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Present MSWD/ Interdepartmental Referral Form1.Recieves the referral Form1.1 Identifies Patient Risk needing Social Work Services.None 10 minutesSocial WorkerMSWD2. Submit Self to any Social Intervention2. Conduct social Intervention depending to the needs 2.1 Collaborates with other health professionals2.2 Do Referrals for custody, safe keeping, and sustainability of support to other agencies.2.3 Update of patient record in the progress notesNone50 MinutesSocial WorkerMSWDTotal:None1 hour29. Vaccination for Follow Up ABTC PatientsAnimal Bite Treatment Center (ABTC) is a part of the out-patient department that provide treatment and management of animal bite victims. Despite of the pandemic the ITRMC OPD ABTC clinic will serve patient following health standard to minimize the spread of the virus. The program aims to attain “Rabies Free Philippines in the year 2030”.Office or Division:Out-Patient DepartmentClassification:Simple Transaction Type of Transaction:G2C- Government to Citizen/G2G- Government to Government/G2B- Government to BusinessWho may avail:All CHECKLIST OF REQUIREMENTSWHERE TO SECUREHealth Declaration Form (1 original copy)Triage AreaABTC Schedule Card (1 original copy)ABTC ClinicCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Submit self for Health Declaration and validation of appointment at the Triage 11. Properly asks patient for any signs and symptoms of related COVID 19 1.1 Instructs patient to wear mask at all times, maintain social distancing, and sanitize hand1.2. Instructs patient to proceed to OPD None 5 minutes Triage OfficerDRMMH2. Proceed to OPD triage for revalidation of Health Declaration and room assignment for consultation 2. Properly asks patient for any signs and symptoms of related COVID 192.1 Instructs patient to wear mask at all times, maintain social distancing, and sanitize handNone 5 minutes NurseOPD3.Submit the Health Declaration Form and ABTC schedule card to the nurse on duty3.Receives ABTC treatment card and instruct patient to wait outside3.1.Enters patient data on logbook3.2 Prepares vaccineNone5 minutesNurseOPD4.Subject self for vaccination and obtain instruction for next vaccination if necessary 4. Calls patient to be vaccinated and instruct patient of next vaccination if necessary. None5 minutesNurseOPDTotal:None20 minutesMedical DivisionNon-Frontline Services1. Dispensing of Medicines for In-PatientA client friendly section provides continuous supply of appropriate medicines to IN patients The scope of pharmacy practice includes more traditional roles such as compounding and dispensing of medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information.Office or Division:Medical Division- Pharmacy SectionClassification:Simple TransactionType of Transaction:G2G- Government to GovernmentWho may avail:Nurses/ Nurse Attendant/ Midwife CHECKLIST OF REQUIREMENTSWHERE TO SECUREWritten Prescription (completely filled) (1 original copy)Prescribing DoctorRequisition for Drug Preparation Containing Controlled Chemical (RIS) (1 original copy)Prescribing Doctor with valid S2 LicenseCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEPresent the prescription to the Pharmacist- RIS for Regulated/ProhibitedDrugs1. Review the prescription / RIS (for regulated or prohibited drugs)1.1 Verify the prescription / RIS to the system (HOMIS)1.2 Prepare corresponding charge slip1.3 Prepare the medicine/s None60 minutesPharmacistPharmacy Section2. Get the medicine/s and sign the charge slip.- RIS (for regulated or prohibited drugs)2. Dispense the medicine/sRefer to table of fees below3 minutesPharmacistPharmacy Section Total: Amount availed will be automatically added to patients hospital bill63 minutesPHARMACY UPDATED PRICE LIST 2020Item DescriptionUnit CostSelling Cost0.9% Sodium Chloride for irrigating 1 liter46.7758.460.9% Sodium Chloride for irrigating 500mL 54.00 67.500.9% Sodium Chloride for irrigating 50mL 44.80 56.000.9% Sodium Chloride IV Infusion 1 liter33.9842.485% Dextrose in Water IV infusion and as vehicle for IV medications 500mL (Plastic) bottle39.7649.705% Dextrose in Lactated Ringer's IV infusion 1 liter bottle/bag 38.10 47.635% Dextrose in Lactated Ringer's IV infusion 500ml bottle/bag 41.10 51.385% Dextrose in Water IV infusion and as vehicle for IV medications 250mL 48.00 60.005% Dextrose in Water IV infusion and as vehicle for IV medications 500ml glass 76.00 95.00 50% Dextrose Solution for IV Injection 50ml 50.00 62.50 50% Glucose (dextrose) (D50-50) (IV) vial, 50ml 50.00 62.50Acetazolamide 250mg 20.00 25.00Acetylcysteine 100mg 9.00 11.25Acetylcysteine 200mg8.7410.93Acetylcysteine 600mg 20.00 25.00Acetylcysteine 600mg Tablet16.05 20.06 Aciclovir 25mg/mL (IV Infusion) 10mL 22.4428.05Aciclovir 400mg 14.10 17.63Aciclovir 800mg 27.98 34.98Adenosine 3mg/ml, 2mL172.22215.28Albumin Human 20% (IV, IV Infusion) , 50 ML2,535.003168.75All-in-one Admixtures Solution Volume: 400-25--mL (protein 3-6g/100mL carbo:6-15g/100mL lipid:2-5g/100mL cal: variable electorytes: 1400 Kcal 1,545.00 1931.25All-in-one Mixtures solution Lipid Peri emulsion for Intravenous Infusion 1875ml 1,680.00 2,100.00 Alprazolam 250mcg 12.00 15.00Alprazolam 500mcg 18.00 22.50Amikacin 250mg vial (IM/IV) (as Sulfate), 2mL22.4428.05Amino Acids, Crystalline Standard 7% (IV Infusion) , 500ml 774.98 968.73Amino Acids, Crystalline Standard 8% (as branched chain) IV infusion 500mL 875.70 1094.63Amiodarone 200mg tablet9.9812.48Amiodarone 50mg/ml ampule279.00348.75Amlodipine Besylate 10mg0.380.48Amlodipine Besylate 10mg Tablet 0.50 0.63 Amlodipine Besylate 5mg0.3120.39Amlodipine Besylate 5mg Tablet 0.27 0.34 Amoxicillin Trihydrate 250mg/ml susp.15.9819.98Amoxicillin Trihydrate 500mg1.391.74Amphotericin B 50mg (IV Infusion) 10,437.0013046.25Ampicillin + Sulbactam ( as sodium salt) 500mg/ 250 per vial (IM,IV)23.4529.31Ampicillin + Sulbactam (as Sodium Salt) 250mg/125mg per vial (IM,IV) 85.00 106.25Ampicillin Sodium 500mg (IM,IV)8.3910.49Anti-rabies Serum (equine) 200IU/ml (IM) , 5ml 1,239.00 1548.75Ascorbic Acid 500mg Tablet 1.00 1.25Ascorbic Acid 500mg tablet 0.68 0.85 Aspirin 80mg 0.881.10 Aspirin 80mg Tablet 0.63 0.79 Atenolol 50mg Tablet1.401.75Atracurium Besilate 10mg/ml , 2.5mL109.88137.35Azithromycin (as base) 500mg tablet8.7810.98 Azithromycin 500mg Tablet 9.45 11.81 Azithromycin 500mg Vial 270.00 337.50 Balanced Multiple Maintenance Solution with 5% Dextrose for Adult IV infusion 1liter bottle/bag 40.00 50.00Balanced Multiple maintenance Solution with 5% Dextrose for Pedia IV Infusion 500mL34.3442.93Balanced Multiple Replacement Solution with 5% Dextrose for Pedia IV Infusion 500mL45.0056.25Benzylpenicillin 1M ampule 12.43 15.54Benzylpenicillin 5M ampule 16.34 20.43Beractant 25mg/ml suspension, 4mL 10,325.00 12906.25Betahistine Hydrochloride 24mg 21.10 26.38Betahistine Hydrochloride 8mg 6.90 8.63 Betahistine Hydrochloride 8mg tablet 5.27 6.59 Biperiden Hydrochloride 2mg4.876.09Biphasic Isophane Human Insulin 70/30 (recombinant DNA) 70% isophane suspension + 30% soluble insulin in 100IU/ml, 10ml120.00150.00Bisacaodyl 10mg Adult22.3927.99Bisacodyl 5mg 13.50 16.88 Bisacodyl 5mg tablet 1.36 1.70 Bleomycin (as sulfate) 15mg vial/ampul2,200.002750.00 Bleomycin 15mg vial 1,938.00 2,422.50 Brinzolamide eye drops1,064.001330.00Bupivacaine 0.5% (spinal) with 8% Dextrose, 4mL78.2297.78Bupivacaine Hydrochloride 0.5% (local infiltration) 10mL92.33115.41Butamirate Citrate 50mg MR 10.49 13.11Butamirate Citrate 50MR Tablet 7.95 9.94 Calcium Carbonate 500mg 1.65 2.06Calcium Folinate (Leucovorin Calcium) 10mg/ml (IM,IV) 5mL 167.05 208.81Calcium Gluconate 10% (IV) 10mL17.2321.54 Candesartan 8mg Tablet 10.50 13.13 Capecitabine 500mg 44.0055.00 Capecitabine 500mg Tablet 37.00 46.25 Captopril 25mg 1.48 1.85Captopril 25mg Tablet 0.39 0.49 Captopril 25mg Tablet 0.39 0.49 Carbamazipine 200mg 3.80 4.75Carbidopa + Levodopa 25mg/ 100mg 15.00 18.75Carbidopa + Levodopa 25mg/ 250mg 23.95 29.94Carboplatin 150mg 780.00 975.00Carboplatin 150mg vial 899.00 1,123.75 Carboplatin 450mg 1,150.00 1437.50Carboplatin 450mg vial 1,890.00 2,362.50 Carboprost 250mcg ampule 337.88 422.35Carvedilol 25mg 5.00 6.25Carvedilol 6.25mg1.381.73Cefalexin Monohydrate 500mg 8.85 11.06 Cefazolin 1g vial 17.42 21.78 Cefazolin Sodium 1g (IM,IV) 17.2321.54 Cefepime 1g Vial 90.00 112.50 Cefepime Hydrochloride 1g (IM, IV)88.33110.41Cefepime Hydrochloride 500mg (IM,IV) 152.34190.43 Cefixime 100mg/5ml 60ml Bottle 120.00 150.00 Cefixime 200mg 6.678.34Cefixime 200mg capsule 6.50 8.13 Cefotaxime 1g vial34.8943.61Cefoxitin Sodium 1g (IM,IV) 83.33104.16Ceftazidime Pentahydrate 1g (IM,IV)41.3351.66Ceftazidime Pentahydrate 500mg (IM,IV) vial651.94814.93Ceftriaxone Disodium/ Sodium Salt 1g + 10mL diluent (IV)22.3227.90Cefuroxime 500mg Tablet 9.50 11.88 Cefuroxime Axetil 500mg 8.8811.10Cefuroxime Sodium 1.5 (IV Infusion) 98.00 122.50Cefuroxime Sodium 750mg (IM,IV) 13.8817.35Celecoxib 200mg3.103.88Celecoxib 200mg capsule 2.00 2.50 Celecoxib 400mg 9.10 11.38Cetirizine Dihydrochloride 10mg 3.42 4.28 Cetirizine Dihydrochloride 10mg Tablet 0.34 0.43 Cetirizine Dihydrochloride 10mg/ml Oral Drops, 10mL 65.56 81.95Cetirizine Dihydrochloride 5mg/5mL Syrup, 30mL 65.00 81.25Chick Embryo Cell (purified inactivated) luophilized powder, 2.5IU/ml, dose vial+ 1 mL diluent (ID, MD) 1,756.15 2195.19Chloramphenicol 0.5% Ear drops 80.00 100.00Chlorhexidine Gluconate Antiseptic: 4% solution, 120ml 139.98 174.98Chlorphenamine 10mg/ml 1ml 10.80 13.50 Chlorphenamine 10mg/ml ampule 10.80 13.50Chlorphenamine 4mg Tablet 1.00 1.25Chlorpromazine Hydrochloride 100mg1.882.35Chlorpromazine Hydrochloride 200mg3.434.29Cilostazol 50mg tablet 8.85 11.06Cilostazole 50mg Tablet 6.93 8.66 Cinnarizine 25mg Tablet 1.10 1.38 Ciprofloxacin 2mg/ml (IV Infusion) , 50ml40.0050.00Ciprofloxacin Hydrochloride 500mg1.632.04Cisplatin 1mg/ml (IV) 50mL 378.00 472.50 Clarithromycin 125mg/5ml Suspension 70ml bottle 138.00 172.50 Clarithromycin 500mg base 11.00 13.75Clindamycin 150mg capsule 3.00 3.75 Clindamycin 300mg Capsule 4.12 5.15 Clindamycin Hydrochloride 300mg 4.89 6.11Clindamycin Phosphate 150mg/ml (IM,IV), 4mL7.639.54 Clindamycin Phosphate 150mg/ml 4ml Ampule 79.50 99.38 Clonidine Hydrochloride 150mcg 23.00 28.75Clonidine Hydrochloride 75mcg5.446.80 Clonidine Hydrochloride 75mcg Tablet 6.00 7.50 Clopidogrel 75mg 1.271.59 Clopidogrel 75mg tablet 1.24 1.55 Cloxacillin (as Sodium Salt) 500mg 6.00 7.50 Cloxacillin 500mg capsule 2.60 3.25 Clozapine 25mg 18.00 22.50Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) (228.5mg)200mg+ 28.5mg per 5mL for Suspension, 70mL 115.76 144.70Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) (312.50mg)250mg+ 62.5 per 5mL granules/powder for Suspension, 60mL 109.16 136.45Co-Amoxiclav (Amoxicillin + Potassium Clavulanate) 625mg Tablet 5.99 7.49 Co-Amoxiclav (Amoxicillin +Potassium Clavulanate ) 625mg (500mg+125mg) per tablet6.007.50Co-Amoxiclav (Amoxicillin +Potassium Clavulanate )1g (875mg+125mg) tablet11.0013.75Colchicine 500mcg 1.79 2.24Cotrimoxazole (Sulfamethoxazole + Trimethoprim) 400mg + 80mg per 5ml Suspension , 60ml 34.10 42.63Cyclophosphamide 500mg (IV) 150.00187.50Cyclophosphamide 1g (IV) 175.00218.75 Cytarabine 100mg vial 122.90 153.63 Dacarbazine 200mg (IV,IV infusion) 565.00 706.25Dacarbazine 200mg powder vial558.00 697.50 Dactinomycin (Actinomycin D) 500mf powder inj. Vial 400.00 500.00Dexamethasone (as Sodium Phosphate ) 4mg/ml (IM, IV) , 2mL11.2314.04Dexamethasone 4mg tablet30.7538.44Diazepam 5mg/ml (IM,IV) , 2mL77.3496.68Digoxin 250mcg 3.904.88Digoxin 50mcg/ml 60ml bottle716.22895.28Diltiazem 60mg Tablet3.103.88Diphenhydramine (as Hydrochloride) 50mg/ml (IM,IV) 1mL24.3230.40Diphenhydramine 50mg capsule2.182.73 Diphenhydramine 50mg Capsule 0.74 0.93 Dobutamine 50mg/ml 5ml ampule 145.35 181.69 Docetaxel (anhydrous) 20mg/0.5mL (iv Infusion),0.5mL 985.20 1231.50Docetaxel (anhydrous) 40mg/mL (iv Infusion),2mL 2,165.45 2706.81Domperidone 10mg 3.50 4.38 Domperidone 10mg tablet 1.30 1.63 Doxorubicin (as Hydrochloride) powder, 10mg 160.00 200.00Doxorubicin (as Hydrochloride) powder, 50mg 532.00 665.00Doxycycline (as Hyclate) 100mg 14.00 17.50Enalapril (as Maleate ) 5mg 5.10 6.38Enoxaparine (as Sodiu Salt) 100mg/ml Pre-filled syringe (SC) 600.00 750.00Enoxaparine (as Sodium Salt) 100mg/ml Pre-filled syringe (SC) 0.4mL 204.33255.41Enteral Nutrition Adult Polymeric,100-475 Kcal,powdder 400g191.00238.75Enteral Nutrition Diabetes,100-1000 Kcal,powder 400g260.00325.00Enteral Nutrition Fiber-containing,100-1048 Kcal,powdder 400g191.00238.75Enteral Nutrition Pediatric Polymeric 445-511 Kcal, Powder 100g380.41475.51Eperisone Hydrochloride 50mg 16.80 21.00Ephedrine Sulfate 50mg/ml , 1ml 77.5096.88Epinephrine (as Hydrochloride) 1mg/ml (IM,SC) 1mL22.3327.91Epoetin Alfa (Recombinant human erythropoetin) 4,000 IU/ml (IV,SC) , 1ml 360.00 450.00 Epoetin Alfa 4,000iu/ml pre-filled syringe 360.00 450.00 Eprirubicin ( as Hydrochloride) 10mg (IV) 657.00 821.25Eprirubicin ( as Hydrochloride) 50mg (IV) 2,678.00 3347.50Ertapenem (as sodium) powder, 1g (IM,IV) 3,088.56 3860.70Erythromycin Eye Ointment 0.005, 3.5g112.11140.14Escitalopram (as Oxalate) 10mg 3.45 4.31Etericoxib 120mg 37.0946.36 Felodipine 5mg ER tablet 7.50 9.38 Fenofibrate 145mg 26.00 32.50Fenofibrate 160mg 19.5024.38FeNtanyl (as Citrate ) 50mcg/ml, 2ml 57.3371.66Ferrous Sulfate + Folic Acid 60mg elemental iron +400mcg folic acid0.720.90Filgrastim 300mcg/ 1ml vial 918.00 1147.50 Filgrastim 300mcg/1.2ml vial 2,652.00 3,315.00 Filgrastim 300mcg/1.2ml vial 900.00 1,125.00 Finasteride 5mg 7.35 9.19Fluconazole 150mg150.00187.50Fluconazole 2mg/ml (IV Infusion) 100mL344.33430.41Fluorouracil 50mg/ml (IV,IV infusion) 10ml 75.00 93.75Fluphenazine Decanoate 25mg/ml, 1ml82.32102.90Fluticasone Nasal Spray 0.05 dose 247.79 309.74Fondaparinux ( as Sodium Salt) 2.5mg, 0.5mL 1,543.50 1929.38 Furosemide 10mg/ml 2ml Ampule 6.48 8.10 Furosemide 10mg/ml, 2mL6.327.90Furosemide 40mg Tablet0.600.75 Furosemide 40mg Tablet 1.55 1.94 Fusidate Sodium/ Fusidic Acid 2% Ointment ,5g 150.00 187.50Gabapentin 100mg 5.90 7.38Gabapentin 300mg 6.20 7.75Gadobutrol 1.0mmol/ml vial, 15ml4,000.005000.00Gemcitabine (as Hydrochloride) 1g (IV Infusion) 2,495.003118.75Gemcitabine (as Hydrochloride) 200mg (IV Infusion) 650.00812.50Gentamicin (as Sulfate) 40mg/ml (IM,IV), 2mL4.485.60 Gentamicin 40mg/ml 2ml Ampule 3.65 4.56 Gliclazide 30mg MR2.503.13Gliclazide 80mg 4.00 5.00 Gliclazide 80mg tablet 2.36 2.95 Gliclazide 80mg tablet 2.36 2.95 Haloperidol 5mg 23.85 29.81Heparin (as Sodium) 1,000 IU/mL (IV,IV Infusion, SC) 5mL42.8853.60Heparin (as Sodium) 5,000 IU/mL (IV,IV Infusion, SC) 5mL250.00312.50 Heparin 5,000IU/ml 5ml vial 160.00 200.00 Heparin 5,000IU/ml 5ml vial 140.00 175.00 Hepatitis B Immunoglobulin (Human)1,998.002497.50 Hydralazine HCI 20mg/ml 1ml Ampule 28.24 35.30 Hydralazine HCL 20mg/ml (IM,IV) 1mL38.2247.78Hydrocortisone (as Sodium Succinate ) 100mg powder (IV) 21.4326.79Hydrocortisone (as Sodium Succinate ) 250mg powder (IV) 67.7884.73 Hydrocortisone 100mg vial 22.36 27.95 Hydrocortisone 250mg vial 64.71 80.89 Hydroxyurea 500mg26.0032.50Hyoscine (as N-butyl Bromide ) 10mg Tablet 4.115.14Hyoscine (as N-butyl Bromide ) 20mg/ml (IM,IV,SC) 1mL 18.3422.93 Hysocine (as N-butyl bromide) 20mg/ml 1ml Ampule 23.53 29.41 Ibuprofen 200mg Tablet 0.95 1.19 Ifosfamide 1g (IV Infusion) 1,650.002062.50Ifosfamide 2g (IV Infusion) 2,400.003000.00Immunoglobulin, Normal Human (IGIV) 50mg/ml , 100ml9,800.0012250.00Insulin Glargine 100iu vial 337.00 421.25Intraocular Irrigating Solution (balanse Salt Solution), 500ml 420.00 525.00Ipratropium Bromide anhydrous + Salbutamol Sulfate 500 mcg + 2.5mg x 2.5 mL soln for inhalation Nebule 10.00 12.50 Ipratropium Bromide annhydrous + Salbutamol Sulfate 500mcg + 2.5mg x 2.5 mL (unit dose Respiratory solution) 13.00 16.25Irbesartan 150mg 3.784.73 Irbesartan 150mg Tablet 3.63 4.54 Irbesartan 300mg 7.20 9.00 Irbesartan 300mg Tablet 6.51 8.14 Iron Sucrose 100mg Ampule 130.00 162.50 Isoflurane 100ml1,300.001625.00Isosorbide -5- Mononitrate 30mg MR 8.00 10.00Isosorbide -5- Mononitrate 60mg MR 6.00 7.50Isosorbide Dinitrate 1mg/ml , 10ml 131.78 164.73Isosorbide Dinitrate 5mg Sublingual/ oral 2.10 2.63Isosorbide Dinitrate 5mg tablet 8.80 11.00 Isosorbide-5-Mononitrate 30mg MR 5.73 7.16 Isotonic Electrolyte Solution for IV infusion 1000ml 246.50 308.13 Isotonic Electrolyte Soulution for IV infusion Each 1L; NaCl 6.80g,KCl-0.30g, CaCl-0.37g,MgCl-0.20g,Na Acetate 3.27g,Malic Acid-0.67g 180.00 225.00Ketamine 50mg/ml ,10mL 532.32665.40Ketoconazole 15g cream115.00143.75Ketorolac Tromethamol 30mg/ml (IM,IV) 1mL 17.8822.35Lactated Ringers Solution IV Infusion , 1 liter 36.10 45.13Lactulose 3.3g/5mL (66%) Syrup 120mL Bottle 59.99 74.99 Lactulose 3.3g/5ml (66%) Syrup, 120ml 140.00 175.00Lansoprazole 30mg capsule 18.00 22.50 Lansoprazole 30mg capsule 20.90 26.13 L-Asparaginase 10000iu vial 1,689.00 2111.25Latanoprost 50mcg eye drops 700.00 875.00Leuprorelin (as Acetate) 3.75mg/2ml with syringe (IM,SC)4,800.006000.00Levofloxacin 500mg 7.00 8.75Levofloxacin 500mg IV 450.75563.44 Levofloxacin 500mg Vial 170.00 212.50 Levofloxacin 750mg 19.00 23.75Levothyroxine (as anhydrous sodium) 100mcg 6.80 8.50Levothyroxine (as anhydrous sodium) 100mcg tablet 5.50 6.88 Levothyroxine (as anhydrous sodium) 25mcg 2.80 3.50Levothyroxine (as anhydrous sodium) 50mcg tablet2.95 3.69 Levothyroxine (as anyhydrous sodium) 50mcg2.953.69Lidocaine Hydrochloride 10% spray, 50mL 2,215.46 2769.33Lidocaine Hydrochloride 2% (as hydrochloride) 5mL8.2210.28Lidocaine Hydrochloride 2% (for epidural local infiltration) ,50ml vial 50.00 62.50Lidocaine Hydrochloride 2% w/ Epinephrine 1.8ml carpule 25.50 31.88Lipids 20% (IV infusion) 250mL 749.00 936.25Loperamide Hydrochloride 2mg capsule 4.95 6.19Loratadine 10mg1.481.85 Loratadine 10mg Tablet 1.52 1.90 Losartan (as Potassium Salt) 50mg0.740.93Losartan + Hydrochlorothiazide 50mg+ 12.5mg 4.50 5.63Losartan 100mg 3.98 4.98Losatan + Hydrochlorothiazide 100mg+ 25mg 3.50 4.38Magnesium Sulfate (as heptahydrate) 250mg/ml (IM,IV) 20ml vial 45.00 56.25 Magnesium Sulfate 25% Solution for Injection, 20ml vial 45.00 56.25 Mannitol 20% (IV) 500mL77.8397.29Mecobalamine 500mcg ampule200.00250.00Mefenamic 50mg/5ml susp35.5044.38Mefenamic Acid 500mg Capsule1.001.25Mercaptopurine 50mg Tablet21.7827.23Meropenem Trihydrate 1g powder (IM,IV) 157.88197.35Meropenem Trihydrate 500mg powder (IM,IV) 104.77130.96 Mesna 100mg/4ml Ampule 147.00 183.75 Metformin Hydrochloride 500mg film coated 1.201.50 Metfromin Hydrochloride 500mg tablet 0.53 0.66 Methimazole 5mg 5.00 6.25Methotrexate 25mg/ml (IM,IV,Intrathecal) 2mL 199.00 248.75Methyldopa 250mg 7.45 9.31Methylprednisolone 16mg 8.20 10.25 Methylprednisolone 1g vial 2,550.00 3,187.50 Methylprednisolone Siodium Succinate 1g lyophilized powder (IM,IV) 3,000.00 3750.00Methylprednisolone Siodium Succinate 500mg lyophilized powder (IM,IV) 2,300.00 2875.00Metoclopramide (as hydrochloride ) 5mg/ml (IM,IV) 2mL3.444.30 Metoclopramide 10mg Tablet 1.78 2.23 Metoclopramide 5mg/ml 2ml 3.42 4.28 Metronidazole 500mg 1.49 1.86Metronidazole 5mg/ml (IV Infusion) 100ml 13.75 17.19Midazolam 1mg/ml (IM,IV) , 5ml 59.50 74.38Midazolam 5mg/ml (IM,IV), 3mL112.22140.28Modified fluid Gelatin( For,erly polymerisate of Degraded Succinylated Gelatin) 4% solution 500mL 940.00 1175.00Montelukast 10mg 6.51 8.14Morphine (as Sulfate) 10mg 26.66 33.33Morphine (as Sulfate) 30mg 76.92 96.15Morphine* (as Sulfate) 10mg/ml (IM,IV,SC) 1ml 65.00 81.25Multivitamins for Adults 1.09 1.36Mupirocin 2% Ointment, 15g 68.00 85.00Nalbuphine Hydrochloride 10mg/ml (IM,IV,SC) 1mL54.3367.91Neostigmine ( as Methylsulfate) 500mcg/ml ( IM,IV, SC) 1mL 118.75 148.44Nepafenac eye susp. 579.00 723.75Nicardipine Hydrochloride 1mg/ml (IV), 10ml 259.00 323.75Nifedipine 10mg 3.40 4.25 Nifedipine 10mg Capsule 3.60 4.50 Nifedipine 5mg 2.98 3.73Nimodipine 30mg tablet 39.78 49.73Non-ionic Contrast 612mg/ml equiv to 300mg/ml iodine, 100mL1,182.221477.78Non-ionic Contrast 636mg/ml equiv to 300mg/ml iodine, 50mL672.33840.41Norepinephrine Bitartrate 1mg/ml (IV infusion) 2mL98.44123.05Norepinephrine Bitartrate 1mg/ml (IV infusion) 4mL189.78237.23Nystatin 100,000 units/ml Suspension, 30ml175.00218.75Ofloxacin 0.3% otic (ear) drops 5mL 180.00 225.00 Ofloxacin 0.3% otic (ear) drops 5ml Bottle 220.00 275.00 Ofloxacin 0.3% otic (ophthalmic) drops 280.00 350.00Olanzapine 10mg 5.45 6.81Omeprazole 20mg1.141.43Omeprazole 40mg20.0025.00Omeprazole 40mg powder + 10mL solvent27.4734.34Ondansetron (as hydrochloride) 2mg/ml (IM,IV) 4mL 106.67133.34Ondansetron (as Hydrochloride) 8mg 140.00 175.00Ondansetron 2mg/ml 4ml Ampule 139.85 174.81 Oral Rehydration Salts 20.5g Sachet 4.30 5.38 Oxacillin (as Sodium) 500mg Vial (IM,IV) 23.00 28.75 Oxacillin 500mg vial 17.65 22.06 Oxiplatin 2g/ml (IV Infusion) 50mL 2,688.00 3360.00Oxycodone 20mg 286.27 357.84Oxycodone HCL 10mg 170.92 213.65Oxycodone HCL 10mg/ml, 2mL 1,771.60 2214.50Oxytocin 10IU/ml ampul (IM,IV), 1mL7.899.86Paclitaxel 6mg/ml (IV,IV Infusion), 17mL 1,465.20 1831.50paclitaxel 6mg/ml (IV,IV Infusion), 5mL 985.20 1231.50Paracetamol (alcohol-free preferred) 250mg/5ml , 60ml 67.50 84.38Paracetamol 100mg/ml Drops 13.70 17.13Paracetamol 100mg/ml Drops 15ml Bottle 13.70 17.13 Paracetamol 10mg/ml , 100ml vial 124.00 155.00Paracetamol 150mg/mL (IM,IV) 2mL (AMADOL) ampule10.0012.50Paracetamol 150mg/mL (IM,IV) 2mL (FEBRINIL) ampule5.226.53Paracetamol 500mg 0.380.48Penicillin G Benzathine 1.2M iu vial49.3361.66Penicillin G Crystalline (benzylpenicillin as Sodium Salt) 1,000,000 units (IM,IV)12.4315.54Penicillin G Crystalline (benzylpenicillin as Sodium Salt) 5,000,000 units (IM,IV)16.3420.43Phenylephrine 2.5% drops457.00571.25Phenytoin (as sodium salt) 100mg capsule7.809.75Phenytoin (as Sodium Salt) 50mg/ml (IV) 2mL84.34105.43Phenytoin 100mg capsule25.0031.25 Phytomenadione 10mg/ml 1ml Ampule 12.95 16.19 Pilocarpine 2% eye drops265.00331.25Piperacillin + Tazobactam (as Sodium Salt) 2g + 250mg (IV Infusion)72.8891.10Piperacillin + Tazobactam (as Sodium Salt) 4g + 500mg (IV Infusion)93.32116.65Piperacillin + Tazobactam 4g +500mg Vial 106.00 132.50 Potassium Chloride 2meq/mL (IV Infusion) 20mL 36.50 45.63Potassium Chloride 600mg 11.00 13.75Potassium Chloride 750mg durules (as Chloride) 10meq 14.50 18.13Potassium Chloride 750mg Tablet 14.50 18.13 Potassium Citrate 10meq7.008.75Prednisone 10mg 2.10 2.63Prednisone 10mg Tablet 0.80 1.00 Prednisone 10mg/5ml Suspension, 60ml 114.00 142.50Prednisone 20mg 5.30 6.63 Prednisone 20mg Tablet 2.36 2.95 Prednisone 5mg 1.80 2.25Prednisone Acetate 1% Eye drops, 5ml 157.00196.25Propanolol 10mg 10.53 13.16Propanolol 40mg 13.60 17.00 Propofol 1% LCT 10mg/ml emulsion for Intravenous Inf. 20ml ampule 65.57 81.96 Propofol 10mg/ml (IV), 20mL 61.10 76.38Propylthiouracil 50mg tablet 8.75 10.94Propylthiouracil 50mg Tablet 10.00 12.50 Rabies Vaccine : Verocell lyophilized powder, 2.5IU/0.5ml vial+diluent (ID,IM)1,100.001375.00 Ranitidine 25mg/ml 2ml Ampule 3.18 3.98 Ranitidine Hydrochloride 150mg 0.720.90Ranitidine Hydrochloride 25mg/ml (IM,IV,IV Infusion) 2mL 3.234.04Ranitidine Hydrochloride 300mg 2.453.06Regular Insulin 150.00 187.50Rifaximin 200mg tablet 79.00 98.75Risperidone 2mg 5.67 7.09Rocuronium 10mg/mL , 5ml 192.22240.28Ropivacaine ampule 383.67 479.59Rosuvastatin (as Calcium Salt) 20mg 6.20 7.75Rosuvastatin (as Sodium Salt) 10mg3.113.89Sacubitril + Valsartan 100mg tablet56.2570.31Salbutamol Sulfate 1mg/ml (unit dose) 2.5mL 5.346.68Salbutamol Sulfate 2mg/ml (unit dose) 2.5ml 11.50 14.38Sertralin Hydrochloride 50mg 8.00 10.00Sevoflurane 250mL4,778.005972.50Silver Sulfadiazine 1% cream 20g 180.00 225.00Silver Sulfadiazine 1% cream 5g 271.74 339.68Simvastatin 20mg 2.803.50Simvastatin 40mg 3.12 3.90Sodium Bicarbonate 1 meq/ml (IV Infusion) Adult, 20ml144.32180.40Sodium Bicarbonate 650mg 1.32 1.65Sodium Bicarbonate 650mg tablet 0.99 1.24 Somatostatin 250mcg (IV,IV infusion) 798.00 997.50Somatostatin 3mg (IV,IV infusion) 5,329.00 6661.25Somatostatin 3mg vial 4,796.10 5,995.13 Spironolactone 25mg 8.35 10.44Sterile Water for injection no preservative , 50ml 35.00 43.75Streptokinase 1,500,000 IU (IV Infusion)3,638.004547.50Streptomycin vial18.0022.50Sucralfate 1g 30.0037.50Suxamethonium (Succinychloline Chloride) 20mg/ml (as chloride) , 10ml144.44180.55Tamoxifen Citrate 20mg 6.508.13Tamsulosin Hydrochloride 200mcg 38.00 47.50Telmisartan + Hydrocholorpthiazide 40mg + 12.5mg 19.23 24.04Telmisartan + Hydrocholorpthiazide 80mg + 12.5mg 34.23 42.79telmisartan 40mg 19.23 24.04Telmisartan 80mg 34.02 42.53 Telmisartan 80mg Tablet 23.21 29.01 Terbutaline Sulfate 500mcg/ml (IM,IV,SC) 1ml 96.43120.54Tetanus Toxoid (IM,IV) 0.5ml32.2240.28Timolol Maleate 0.5% Eye drops Solution, 5ml284.00355.00Tobramycin + Dexamethasone 0.3 % +0.1 % Eye drops Solution, 5ml167.00208.75Tobramycin 0.3% Eye Drops Solution, 5mL 180.00 225.00Tramadol Hydrochloride 50mg (as hydrochloride) 2.18 2.73 Tramadol Hydrochloride 50mg Capsule 2.00 2.50 Tramadol Hydrochloride 50mg/ml (IM,IV,SC) , 1ml 40.00 50.00Tramadol Hydrochloride 50mg/ml (IM,IV,SC) , 2ml 10.38 12.98Tranexamic Acid 100mg/ml (IM,IV) , 5ml14.2117.76Tranexamic Acid 500mg 5.69 7.11Trimetazidine 35mg (hydrochloride) 3.894.86Tropicamide + Phenylephrine HCl 5mg + 5mg/ml Ophthalmic Solution 10ml 665.00 831.25Ursudeoxychlolic Acid 250mg33.0041.25Valaciclovir 500mg tablet 31.61 39.51Valproate Disodium/ Valproic Acid 250mg 27.57 34.46Valproic Acid 250mg Tablet 20.00 25.00 Valsartan 160mg tablet 35.00 43.75Vancomycin Hydrochloride 500mg (IV)183.34229.18Verapamil Hydrochloride 2.5mg/ml (IV), 2mL 200.00 250.00Verapamil Hydrochloride 40mg 30.00 37.50Vinblastine Sulfate 1mg/ml , 10ml 890.321112.90Vincristine (as Sulfate ) 1mg/ml , 1ml298.00372.50Vincristine 1mg/ml (IV), 2mL 450.00 562.50 Vitamin B Complex 3ml Ampule 17.65 22.06 Vitamin B Complex B1 B6 B12 100mg + 5mg +50mcg1.702.13Vitamine B Complex : B1 B6 B12 100mg +100mg +1mg (IV), 3ml 29.98 37.48Warfarin 1mg 17.63 22.04Warfarin 2.5mg 10.00 12.50Warfarin 5mg 12.00 15.00Zinc Solution (as Sulfate Monohydrate ) solution (equiv. to20mg elemental syrup + ascorbic) , 60mL 31.79 39.74Zoldipem 10mg 31.85 39.812. Newborn Hearing Screening (In Patient)Screening for hearing loss within the first 4 weeks or 28 days of life.Office or Division:Medical Division- ENTClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:In-patientCHECKLIST OF REQUIREMENTSWHERE TO SECURENewborn Hearing Registry Cards (1 original copy)ENT- HNS DepartmentChart (Doctor’s Order) (1 original copy)OB- GYN Department/ Neonatal Intensive Care UnitCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Present doctor’s order/request form.1. Receives and validate doctor’s order/request form.None 5 minutesHearing ScreenerENT2. Receive information regarding the importance of hearing screening.2. Explains to the newborn’s mother the importance of hearing screening within 4 weeks or 28days of life.None3 minutesHearing ScreenerENT3. Prepare newborn for examination.3. Fill ups newborn hearing registry card for result purposes and perform the procedure.None10 minutesHearing ScreenerENT4.Receive advise and health teachings.4. Provides health teaching to the parents/guardian regarding hearing screening and advise them that it is important to consult child’s doctor if there is any change or problems regarding their child’s hearing.None 5 minutesHearing ScreenerENT5. Receive charge slip and the newborn hearing registry card (Result).5. Prepares charge slip and give the blue and white newborn hearing registry card (result) to the mother/guardian.P200(except for NBB patients)3minsHearing ScreenerENT6.Payment In-patient 6.1 In -patient Non Phic member – Give charge slip to the OB Nurse on Duty. 6.2 In-patient Phic Member – Keep charge slip and the blue and white newborn registry card(result) and wait for the OB nurse on duty to get it whenever they are about to be discharge.6.1 Gets charge slip from the mother and attach it to the face sheet.6.2 Gets the charge slip and the blue registry card (result) and attach it to the facesheet when they are about to discharge.None 10minutes (if the patient is for discharge)NurseOB-GyneTotal:P200.00 (except NBB)36 minutes3. In-Patient X-rayThe Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:In Patient CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianLaboratory Result (Creatinine) (1 original copy)Laboratory DepartmentPatient’s chart (1 original copy)Patient’s WardCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area for routine X-ray. Imaging modality request form with patient’s chart for special procedures1. Presents request form at the reception area for verification of the Radiologic Technologist on duty for routine X-rays and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsIssuance of charge slip2. Patients will be charge immediately and will reflect on patient’s bill.Amount will be based on the availed procedure (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentActual Examination3. Radiologic Technologist on duty will perform the requested examination.NoneRefer tot able of procedural time belowRadiologic Technologist/Radiology ResidentRadiology DepartmentReleasing of official results4. Official result will be spindled with patient’s respective wardNone24 hrs for routine48 hrs for special procedureRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the availed procedure(it we be added in the hospital bill)Routine:1 day, 8 minutesSpecial:2 days, 8 minutesRADIOLOGY DEPARTMENTPROCEDURAL TIMEAbdomen AP (Adult/Pedia) PortableAbdomen APL (Portable)Chest AP Portable- 200.00Chest APL Pedia (Portable)Pelvis AP Portable Abdomen APL- (Pedia) Abdomen DecubitusAnkle (Mortise View)Ankle APAnkle APLAnkle APL/Mortise ViewArm APArm APLAxillary ViewBabygramCalcaneal ViewCanale ViewCervical APLCervical Spine LateralCervical Spine Right and Left ObliquesCervicothoracic Spine APLChest AP/PA AdultChest PAL (Adult)Chest APL (Pedia) Chest Right/Left Lateral DecubitusClavicle APCoccyx APLElbow APLFemur APFemur APLFetogramAbdomen Supine and UprightFoot APL/ObliqueFoot APOLForearm APForearm APLGreenspan ViewHand APOHand APOLHip Joint APHumerus APInvertogramJones ViewKnee (Skyline View)Knee (Sunrise View)Knee Joint APLKnee Joint APOLLeg APLeg APLLumbosacral Right and Left ObliquesLumbosacral APLMandible APOMastoid SeriesNasal Bone LateralParanasal SinusesPelvis (Frogleg)Pelvis (Iliac View)Pelvis (Inlet)Pelvis (Outlet)Pelvis (Obturator View)Pelvis APPelvis APLPlain Abdomen APPlain KUBSacrum APLScaphoid SeriesScapular Y ViewSerendipity ViewShoulder APShoulder Joint Trauma SeriesSkull AP onlySkull APLSkull APL/Towne’sSkull Caldwell’s ViewSkull-Tangential ViewSkull Towne’s ViewSkull Water’sSoft Tissue Neck LateralSubmento-Vertical ProjectionTemporo Mandibular Joint APOThoracic CageThoracic Spine APLThoraco-Lumbar Spine APLWrist APLZanca ViewSpecial Procedure:Close Reduction (Long bone-OR)Close Reduction (Short bone-OR)Intra-operative CholangiogramRetrograde PyelogramArteriogramBarium EnemaBarium SwallowCardiac SeriesColonogramCystogramCystourethrogramFistulogramHysterosalphingogramIntravenous PyelogramSialogramSinugramSkeletal SurveySmall Intestinal SeriesT-tube CholangiogramTube NephrogramUpper Gastro Intestinal SeriesUrethrogram15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes10 minutes15 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes10 minutes15 minutes10 minutes10 minutes15 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes10 minutes15 minutes15 minutes10 minutes10 minutes10 minutes15 minutes10 minutes15 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes15 minutes15 minutes15 minutes15 minutes60 minutes60 minutes30 minutes60 minutes60 minutes90 minutes45 minutes90 minutes90 minutes30 minutes45 minutes45 minutes45 minutes90 minutes45 minutes45 minutes30 minutes60 minutes30 minutes90 minutesPRICE LIST ON X-RAYRoutine:Abdomen AP (Adult/Pedia) Portable- 200.00Abdomen APL (Portable)-400.00Chest AP Portbale- 200.00Chest APL Pedia (Portable)- 300.00Pelvis AP Portable- 200.00Abdomen APL- (Pedia) 200.00Abdomen Decubitus- 150.00Ankle (Mortise View)- 150.00Ankle AP- 150.00Ankle APL- 150.00Ankle APL/Mortise View- 250.00Arm ap- 150.00Arm APL- 200.00Axillary View- 150.00Babygram- 200.00Calcaneal View- 150.00Canale View- 150.00Cervical APL- 200.00Cervical Spine Lateral- 100.00Cervical Spine Right and Left Obliques- 250.00Cervicothoracic Spine APL- 550.00Chest AP/PA Adult- 150.00Chest PAL (Adult)- 300.00Chest APL (Pedia)- 200.00Chest Right/Left Lateral Decubitus- 150.00Clavicle AP-150.00Coccyx APL- 250.00Elbow APL-150.00Femur AP- 150.00Femur APL- 300.00Fetogram- 150.00Abdomen Supine and Upright- 300.00Foot APL/Oblique-150.00Foot APOL- 250.00Forearm Ap-150.00Forearm APL- 200.00Greenspan View- 150.00Hand APO-150.00Hand APOL-250.00Hip Joint AP- 150.00Humerus AP-150.00Invertogram- 300.00Jones View-150.00Knee (Skyline View)- 150.00Knee (Sunrise View)- 150.00Knee Joint APL- 150.00Knee Joint APOL- 250.00Leg AP- 150.00Leg APL-300.00Lumbosacral Right and Left Obliques- 250.00Lumbosacral APL- 250.00Mandible APO- 200.00Mastoid Series- 300.00Nasal Bone Lateral- 100.00Paranasal Sinuses- 150.00Pelvis (Frogleg)- 150.00Pelvis (Iliac View)- 150.00Pelvis (Inlet)- 150.00Pelvis (Outlet)- 150.00Pelvis (Obturator View)- 150.00Pelvis AP- 150.00Pelvis APL-300.00Plain Abdomen AP- 150.00Plain KUB- 150.00Sacrum APL- 250.00Scaphoid Series- 300.00Scapular Y View- 150.00Serendipity View- 150.00Shoulder AP- 150.00Shoulder Joint Trauma Series- 450.00Skull AP only- 100.00Skull APL- 200.00Skull APL/Towne’s- 300.00Skull Caldwell’s View- 100.00Skull-Tangential View- 100.00Skull Towne’s View- 100.00Skull Water’s- 100.00Soft Tissue Neck Lateral- 100Submento-Vertical Projection- 100.00Temporo Mandibular Joint APO- 200.00Thoracic Cage- 150.00Thoracic Spine APL-250.00Thoraco-Lumbar Spine APL- 550.00Wrist APL- 150.00Zanca View- 150.00Special Procedure:Close Reduction (Long bone-OR)- 600.00Close Reduction (Short bone-OR)- 500.00Intra-operative Cholangiogram- 1,500.00Retrograde Pyelogram- 900.00Arteriogram- 700.00Barium Enema- 1,200.00Barium Swallow-850.00Cardiac Series- 800.00Colonogram- 1,200.00Cystogram- 800.00Cystourethrogram- 1,500Fistulogram- 1,400.00Hysterosalphingogram-1,400.00Intravenous Pyelogram- 900.00Sialogram- 900.00Sinugram- 700.00Skeletal Survey-2,000.00Small Intestinal Series-850.00T-tube Cholangiogram- 800.00Tube Nephrogram- 900.004. In-Patient CT Scan The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:In Patient CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianPatient’s Chart (1 original copy)Patient’s WardLaboratory Result (Creatinine) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLEVerification of scheduled patient for CT Scan1. Verifies the scheduled patients for CT ScanNone5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Charges immediately and will reflect on patient’s bill.Amount will be based on the availed procedure (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentActual Examination3. Performs the requested examination.3.1 Instructs patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table of procedural time belowRadiologic Technologist/ Radiology ResidentsRadiology DepartmentReleasing of official results Official result will be spindled with patient’s respective wardNone2 daysRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the availed procedure and it will be added in the hospital bill (refer to table of fees below)2 days and 8 minutes+ processing time of the procedure availed (refer to table of procedural time below)RADIOLOGY DEPARTMENTPROCEDURAL TIMECranial Orbits Temporal BoneParanasal SinusesOral Cavity Mandible Neck Chest High Resolution Chest Upper AbdomenTriphasic Scan of the Liver Lower Abdomen Whole Abdomen Triphasic/Dynamic Scan Whole Abdomen StonogramPelvic Cervical Spine Thoracic Spine Lumbar SpineUpper Extremity Lower Extremity Brain Angiogram Upper Extremity AngiogramLower Extremity Angiogram Guided Biopsy 10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes15 minutes30 minutes30 minutes30 minutes30 minutes30 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes30 minutes30 minutes30 minutes60 minutesPRICE LIST ON CT SCANCranial – 2,500.00Orbits – 3,000.00Temporal Bone – 3,000.00Paranasal Sinuses – 3,000.00Oral Cavity – 3,000.00Mandible – 3,000.00Neck – 3,000.00Chest – 3,000.00High Resolution Chest – 7,000.00Upper Abdomen – 3,000.00Triphasic Scan of the Liver – 8,000.00Lower Abdomen – 3,000.00Whole Abdomen – 5,100.00Triphasic/Dynamic Scan Whole Abdomen – 10,000.00Stonogram – 3,000.00Pelvic – 3,000.00Cervical Spine – 3,200.00Thoracic Spine – 3,200.00Lumbar Spine – 3, 200.00Upper Extremity – 3,200.00Lower Extremity – 3, 200.00Brain Angiogram – 8,000.00Upper Extremity Angiogram – 15,000.00Lower Extremity Angiogram – 15,000.00Guided Biopsy – 2,500.005. In-Patient Dental Radiography The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple Transaction Type of Transaction:G2C- Government to CitizenWho may avail:In Patient CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Presents request form at the reception area for verification of the Radiologic Technologist on dutyNone5 minutesRadiologic Technologist/Radiology ResidentRadiology DepartmentIssuance of charge slip2. Patient will be charge immediately and will reflect on patient’s bill.Panoramic- 800.00Cephamlometric- 800.003 minutesRadiologic TechnologistRadiology DepartmentActual Examination3. Perform the requested examination.3.1 Instructs patient to go back to their requesting physician for evaluation and management after the examinationNone15 minutesRadiologic Technologist/Radiology ResidentRadiology DepartmentReleasing of official results 4. Official result will be spindled with patient’s respective wardNone8 hoursRadiologic TechnologistRadiology DepartmentTotal:P 800.00 (automatically added in the hospital bill)1 day and 23 minutes6. In-Patient MRI The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Complex Transaction Type of Transaction:G2C- Government to CitizenWho may avail:In Patient CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 copy)Requesting PhysicianLaboratory Result (Creatinine) (1 copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Verification of the Radiologic Technologist on duty for routine MRI and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Radiologic Technologist/Radiology ResidentRadiology DepartmentIssuance of charge slip2. Patient will be charge immediately and will reflect on patient’s bill.Amount will be based on the procedure done (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentActual Examination3. Perform the requested examination.3.1 Instruct patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table of procedural time belowRadiologic Technologist/Radiology ResidentRadiology DepartmentReleasing of official results 4. Official result will be spindled with patient’s respective wardNone3 daysRadiologic TechnologistTotal:Amount will be based on the procedure done (refer to table of fees below)(it will be added in the hospital bill)3 days and 8 minutesRADIOLOGY DEPARTMENT PROCEDURAL TIMECranial Orbits Temporal BoneParanasal SinusesOral Cavity Mandible Neck Chest High Resolution Chest Upper AbdomenTriphasic Scan of the Liver Lower Abdomen Whole Abdomen Triphasic/Dynamic Scan Whole Abdomen StonogramPelvic Cervical Spine Thoracic Spine Lumbar SpineUpper Extremity Lower Extremity Brain Angiogram Upper Extremity AngiogramLower Extremity Angiogram Guided Biopsy 10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes10 minutes15 minutes15 minutes30 minutes30 minutes30 minutes30 minutes30 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes15 minutes30 minutes30 minutes30 minutes60 minutesPRICELIST ON MRIBrain MRI - 7,000.00Brain MRA - 7,900.00Brain MRI + MRA - 11,920.00Brain MRI + MRV – 11,920.00Brain MRI + MRA + MRV – 18,920.00Brain MRS – 27,000.00Sella Turcica – 10,700.00Orbits – 7,500.00Paranasal Sinuses – 10,700.00Internal Auditory Canal – 10,700.00Brachial Plexus – 6,550.00Chest – 6,550.00Breasts – 9,800.00Shoulder – 6,550.00Forearm/Arm – 6,550.00Hand/Wrist – 6,550.00Pelvis – 6,550.00Femur/Leg – 6,550.00Foot/Ankle – 6,550.00Knee – 6,550.00Upper Abdomen – 9,000.00Lower Abdomen – 9,000.00Whole Abdomen – 14,000.00MRCP- 13,500.00Whole Abdomen + MRCP – 27,000.00Cervical Spine – 6,550.00Thoracic Spine – 6,550.00Lumbar Spine – 6,550.00Cervico-Thoracic – 13,500.00Thoraco-Lumbar- 13,500.00Whole Spine – 19,650.00Hip (Unilateral) – 6,550.007. In-Patient Ultrasound The Radiology Department provides high quality imaging healthcare services to the public. The Department is a state-of-the-art radiology facility staffed by experienced and competent radiologists, certified by the Philippine College of Radiology (PRC). Services include:General Radiology (X-Rays)CT ScanMRIUltrasoundOffice or Division:Medical Division- Radiology DepartmentClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:In Patient CHECKLIST OF REQUIREMENTSWHERE TO SECUREImaging Modality Request Form (1 original copy)Requesting PhysicianPatient’s Chart (1 original copy)Patient’s WardClaim Slip (1 original copy)Radiology DepartmentLaboratory Result (CTBT,Platelet) (1 original copy)Laboratory DepartmentCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit the Imaging Modality Request Form at the Reception Area1. Receives request form at the reception area for verification of the Radiologic Technologist on duty for routine Ultrasound and Radiology Residents for special procedures for scheduling and preparation.None5 minutesRadiologic Technologist/ Radiology ResidentsRadiology DepartmentIssuance of charge slip2. Patient will be charge immediately and will reflect on patient’s bill.Amount will be based on the availed procedure (refer to table of fees below)3 minutesRadiologic TechnologistRadiology DepartmentActual Examination3. Radiologic Technologist on duty will perform the requested examination.3.1 Instructs patient to go back to their requesting physician for evaluation and management after the examinationNoneRefer to table of procedural time belowRadiologic Technologist/ Radiology ResidentsRadiology DepartmentReleasing of official results 4. Official result will be spindled with patient’s respective wardNone1 dayRadiologic TechnologistRadiology DepartmentTotal:Amount will be based on the availed procedure and it will be added in the hospital bill (refer to table of fees below)1 day and 8 minutes+ time of the procedure done (refer to table of procedural time below)RADIOLOGY DEPARTMENT PROCEDURAL TIMEThyroid/NeckChest/Hemithorax Whole Abdomen Abdomen + Pelvic Abdomen + Prostate Upper Abdomen HBT Pancreas/Spleen Liver HBT + Kidneys HBT + Pancreas HBT + Abdominal Aorta HBT + Kidneys + Spleen HBT + Pelvic Gallbladder Kidneys Abdominal Aorta Urinary BladderPelvic Prostate Scrotal/Testicular/Inguinal Biophysical Scoring (BPS) KUB KUB-Prostate Cranial Cardiac Breasts Transvaginal Section (TVS) Transrectal Section (TRS) Fetal Biometry Emergency Ultrasound (E-Fast) Soft Tissue Biopsy Ultrasound Use (For Biopsy/Catheter Insertion) 20 minutes15 minutes30 minutes30 minutes30 minutes20 minutes15 minutes15 minutes10 minutes20 minutes15 minutes20 minutes30 minutes20 minutes15 minutes20 minutes15 minutes15 minutes20 minutes15 minutes20 minutes 30 minutes20 minutes20 minutes15 minutes20 minutes30 minutes15 minutes15 minutes30 minutes15 minutes15 minutes30 minutes30 minutesPRICE LIST ON ULTRASOUNDThyroid/Neck – 450.00Chest/Hemithorax – 450.00Whole Abdomen – 500.00Abdomen + Pelvic – 550.00Abdomen + Prostate – 500.00Upper Abdomen – 400.00HBT – 300.00Pancreas/Spleen – 300.00Liver – 300.00HBT + Kidneys – 350.00HBT + Pancreas – 350.00HBT + Abdominal Aorta – 350.00HBT + Kidneys + Spleen – 450.00HBT + Pelvic – 350.00Gallbladder – 300.00Kidneys – 300.00Abdominal Aorta – 300.00Urinary Bladder – 300.00Pelvic – 300.00Prostate – 300.00Scrotal/Testicular/Inguinal – 450.00Biophysical Scoring (BPS) – 500.00KUB – 400.00KUB-Prostate – 450.00Cranial – 450.00Cardiac – 450.00Breasts – 450.00Transvaginal Section (TVS) – 450.00Transrectal Section (TRS) – 450.00Fetal Biometry – 450.00Emergency Ultrasound (E-Fast) – 500.00Soft Tissue – 450.00Biopsy – 500.00Ultrasound Use (For Biopsy/Catheter Insertion) – 500.00Nursing Service DivisionFrontline Service1. Hemodialysis TreatmentTreatment for hemodialysis usually takes place in hemodialysis unit. This is a special area that is equipped with machines that perform the dialysis treatment. This is also the place where patients can receive dietary counseling and help with social needs.Office or Division:Nursing Division- Hemodialysis UnitClassification:Simple Transaction Type of Transaction:G2C- Government to CitizenWho may avail:All clients indicated for HD/PD treatmentsCHECKLIST OF REQUIREMENTSWHERE TO SECUREStatement of Account/Charge Slip (1 original copy)Philhealth/Billing SectionsCost Centers- (Pharmacy, Radiology, Laboratory, Dental, Emergency and Out-Patient DepartmentOfficial Receipt of payment/ HD Passport (1 original copy)Hemodialysis UnitPBEF ( Situational requirement) (1 original copy)Billing and Claims SectionCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Register at Hemodialysis Unit1. Registers all OPD patients upon arrival of the unit in accordance to their respected treatment schedule.1.1 Explains procedure and assesses patient. Vital signs assessment and accomplishment of safety checklist1.2 Designates machine assignmentNone 10 minutesNephrologyNurse I or Nurse IIHDU2.Proceed to designated treatment machine2. Prepares patient machine for treatment then proceed with Dialysis treatmentNone4 hoursNephrologyNurse I or Nurse IIRenal TechnicianHDU3. Claim Statement of Account (SOA) at Billing Office3. Instructs watchers or patients to claim their Statement of Account (SOA) at Billing OfficeNone5 minutesAdministrative AssistantHDU4.Pays appropriate charges at the Cashier’s Office4.Receives payment and Issues Official ReceiptExcess from PHIC Package5 minutesAdministrative AssistantHDU5.Presentation of settled/paid Statement of Account5.Receives and logs Official Receipt number5.1 Signing of HD passport5.2 File copy of SOANone5 minutesNephrologyNurse I or Nurse IIHDU6.Receives Post Treatment care and advices 6. Provides Post Treatment Care and Health Teaching and instruction for the next HD scheduleNone 10 minutes NephrologyNurse I or Nurse IIHDUTotal:Excess from PHIC Package 4 hours and 35 minutesNursing Service DivisionNon- Frontline Services1. Discharging Patient from Clinical Areas (NON-COVID)This service is provided to all patient and representatives admitted in the Non-COVID clinical areas.Office or Division:Nursing Division- Clinical AreasClassification:Simple TransactionType of Transaction:G2C-Government to CitizenWho may avail:Patient(s)Patient’s Representative: Relative(s) or Legal Guardian(s) of the PatientCHECKLIST OF REQUIREMENTSWHERE TO SECUREWritten discharge order from physician (1 original copy)Nurse’s Station, written of Patient’s medical RecordsDischarge Clearance Slip (1 original copy)Nurse’s Station where the patient is admittedPhilHealth Forms:*Primary requirements:PBEF (1 original copy)CSF (1original copy)PMRF (if necessary, 1 original copy)*Secondary Requirements:Current PhilHealth Contribution Receipt (1 original copy)Billing and Claims SectionBilling and Claims SectionBilling and Claims SectionPhilHealth/ Satellite Office, CSI City Mall, City of San Fernando, La Union * If expired patient:Birth Certificate/ Baptismal/ Marriage Certificate/ Death Certificate (with registry number, 1 photocopy)Philippine Statistics Authority, Biday, City of San Fernando, La UnionPHIC ID or any valid ID (1 original copy)PhilHealth/ Satellite Office, CSI City Mall, City of San Fernando, La Union4P’s ID/ Pantawid Certification (1 original copy)CSWD Office* Newborn Patient:Marriage Contract of Parents (1 original copy)If not married, Community Tax Certificate (1 original copy each parent)Parent(s) Valid IV (1 original copy)Philippine Statistics Authority, Biday, City of San Fernando, La UnionBarangay Hall/ Municipal Hall/ City Hall (where the patient reside)POS (Point of Service) Certificate (1 original copy)Medical Social Work Department (MSWD) of the hospital* For patient who undergo surgical procedure:OR Technique (1 original copy)Anesthesia Record (1 original copy)Patient Chart at Nurse’s Station where the patient is admittedAll laboratory/ Radiology/ Diagnostic Results (1 original copy)Patient Chart at Nurse’s Station where the patient is admitted*Optional requirements:Senior Citizen ID (1 photocopy)PWD ID/ Certificate (1 photocopy)MSWD/ CSWD/OSCA where the patient residesCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Receive notice of discharge/ Discharge Clearance Slip1.1 Accomplish requirements on Clearance Slip from the different units1. Writes discharge order and inform notice of discharge1.1 Instructs to accomplish discharge process/ clearance slip1.2 Checks and completes patient’s chart1.3 Accomplishes the necessary PhilHealth requirementsNone1 hour Attending PhysicianWard/Unit2. Return accomplished Clearance Slip and requirements to Nurse Station where the patient is admitted2. Checks the completeness of requirements2.1 Forward requirements to Billing and Claims SectionNone10 minutesNurse On-DutyWard/ Unit3. Receive notice from Nurse’s Station if Statement of Account (SOA) is available from Billing and Claims Section3. Receive and process the documents of patientNone1 hour and 20 minutesBilling Clerk Billing and Claims Section3.2 Prepare patient Statement of Account (SOA)/ Billing Statement with reference to charge slips and review/ verify data from iHOMISBilling Clerk Billing and Claims Section4. Receive and sign printed SOA from the Billing and Claims Section4. Issues SOA to watcher/ representativeNone5 minutesBilling Clerk Billing and Claims Section 5. If able to pay, proceed to Cashier Section* If client needs further financial assistance, proceed to Medical Social Work Department (MSWD) for assistance, classifications and discount.5. Receives payment and SOA with indicated amount to be paid* Instructs watcher to proceed to MSWDPHIC case rate for NBBFor Non-PHIC, charge to patient’s bill (# of items X quantity issued)30 minutesCashier StaffCash SectionSocial WorkerMSWD6. Receive the copy of paid SOA or Official Receipt and “OK for Discharge” Slip6. Stamps cleared, issue paid SOA and “OK for Discharge” SlipNone5 minutesCashier StaffCash Section7Present the cleared SOA or Official receipt and “OK for Discharge” Slip to Nurse’s Station where the patient is admitted7.1. Receive home instructions and Alagang Pinoy Tagubilin Form7. Receives and checks copy of cleared SOA, Official Receipt and “OK for Discharge” Slip 7.1. Logs payment on logbook7.2 Discuss all information written in the Tagubilin FormNone35 minutesNurse On-DutyWard/ Unit8. Accomplishes and submits Customer Feedback Form3.1 Consolidates and analyzes submitted Customer Feedback FormNone5 minutesNurse Ward/Unit9. Present the “OK for Discharge” Slip to the guard and exits the hospitalReceives and checks discharge slipNone5 minutesSecurity GuardTotal:Sum of computed bills4 hours2. Discharging Patient from Clinical Areas (COVID)This service is provided to all patient and representatives admitted in the COVID clinical areas with order for discharge, Home against Medical Advise (HAMA), Transfer to Hospital of Choice (THOC), Home Per Request (HPR) and expired patients. This can be avail everyday.Office or Division:Nursing Service Division- Clinical AreasClassification:Simple TransactionType of Transaction:G2C-Government to CitizenWho may avail:Patient’s Representative: Relative(s) or Legal Guardian(s) of the PatientCHECKLIST OF REQUIREMENTSWHERE TO SECUREWritten discharge order from physician (1 original copy)Nurse’s Station, written of Patient’s medical RecordsDischarge Clearance Slip (1 original copy)Nurse’s Station where the patient is admittedPhilHealth Forms:*Primary requirements:PBEF (1 original copy)CSF (1 original copy)PMRF (if necessary, 1 original copy)*Secondary Requirements:Current PhilHealth Contribution Receipt (1 original copy)Billing and Claims SectionBilling and Claims SectionBilling and Claims SectionPhilHealth/ Satellite Office, CSI City Mall, City of San Fernando, La Union * If expired patient:Birth Certificate/ Baptismal/ Marriage Certificate/ Death Certificate (with registry number, 1 photocopy)Philippine Statistics Authority, Biday, City of San Fernando, La UnionPHIC ID or any valid ID (1 original Copy)PhilHealth/ Satellite Office, CSI City Mall, City of San Fernando, La Union4P’s ID/ Pantawid Certification (1 original copy)CSWD Office* Newborn Patient:Marriage Contract of Parents (1 original copy)Philippine Statistics Authority, Biday, City of San Fernando, La UnionIf not married, Community Tax Certificate (1 original copy each parent)Parent(s) Valid IV (1 original copy)Barangay Hall/ Municipal Hall/ City Hall (where the patient reside)POS (Point of Service) Certificate (1 original copy)Medical Social Work Department (MSWD) of the hospital* For patient who undergo surgical procedure:OR Technique (1 original copy)Anesthesia Record (1 original copy)Patient Chart at Nurse’s Station where the patient is admittedAll laboratory/ Radiology/ Diagnostic Results (1 original copy)Patient Chart at Nurse’s Station where the patient is admitted*Optional requirements:Senior Citizen ID (1 photocopy)PWD ID/ Certificate (1 photocopy)MSWD/ CSWD/OSCA where the patient residesCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Receive notice of discharge/ Discharge Clearance Slip1.1 Accomplish requirements on Clearance Slip from the different units1. Write discharge order and inform notice of discharge1.1 Instructs to accomplish discharge process/ clearance slip1.2 Checks and completes patient’s chart1.3 Accomplishes the necessary PhilHealth requirementsNone1 hour Attending PhysicianWard/Unit2 Return accomplished Clearance Slip and requirements to Nurse Station where the patient is admitted2. Checks the completeness of requirements2.1. Forward requirements to Billing and Claims SectionNone10 minutesNurse Ward/ Unit3. Receive notice from Nurse’s Station if Statement of Account (SOA) is available from Billing and Claims Section3. Receive and process the documents of patient3.1 Prepare patient Statement of Account (SOA)/ Billing Statement with reference to charge slips and review/ verify data from iHOMISNone1 hour 25 minutesBilling Clerk Billing and Claims 4. Receive and sign printed SOA from the Billing and Claims Section4. Issues SOA to watcher/ representativeNone5 minutesBilling Clerk Billing and Claims5 If able to pay, proceed to Cashier Section* If client needs further financial assistance, proceed to Medical Social Work Department (MSWD) for assistance, classifications and discount.5.1 Receives payment and SOA with indicated amount to be paid* Instructs watcher to proceed to MSWDPHIC case rate for NBBFor Non-PHIC, charge to patient’s bill (# of items X quantity issued)30 minutesCashier StaffCash SectionSocial WorkerMSWD6. Receive the copy of paid SOA or Official Receipt and “OK for Discharge” Slip6. Stamps cleared, issue paid SOA and “OK for Discharge” SlipNone5 minutesCashier StaffCash Section7. Present the cleared SOA or Official receipt and “OK for Discharge” Slip to Nurse’s Station where the patient is admitted7.1 Receive home instructions and Alagang Pinoy Tagubilin Form7. Receives and checks copy of cleared SOA, Official Receipt and “OK for Discharge” Slip 7.1. Logs payment on logbook7.2 Discuss all information written in the Tagubilin7.3 Informs Operation Center regarding discharge7.4 Coordinates with RESU and PHONone35 minutesNurse Ward/ UnitOPCEN Staff DRMMHHNone8. Pick up by their municipal ambulance and exits the hospital8. Transfers patient safely to the ambulanceNone10 minutesPatient TransporterWard/UnitTotal:Sum of the computed bills4 hours3. Nursing Office TransactionOffice or Division:Nursing Service Division-Nursing OfficeClassification:Simple TransactionType of Transaction:G2C- Government to Citizen/G2B- Government to Government/G2G- Government to BusinessWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECURECommunication Letter of any kind if applicable (1 original copy)Requesting PartyCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Proceeds to the Secretary, 1st table and relay purpose of visit1.1 Submits document and other record if applicable1. Greets client1.1 Checks and validates submitted documentNone3 minutesNursing PersonnelNursing Office2. Waits for any response or further instruction regarding the intent2.1 Obtains receiving copy if applicable2. Instructs client regarding the intentNone10 minutesNursing PersonnelNursing Office3 Accomplishes and submits Customer Feedback Form3.1 Consolidates and analyzes submitted Customer Feedback FormNone5 minutesNursing PersonnelNursing Office4. Termination of Transaction4.1 Greets clientNone3 minutesNursing PersonnelNursing OfficeTotal:None25 minutesBeing ISO 9001:2015 certified, the Nursing Service Division adopts a quality culture. Thus, all employees are expected to commit to being client-focused and continually look for ways to improve the quality of services delivered to customers, and actively obtain and respond to their expectations and suggestions. The office also implements a “No Noon Break Policy” to ensure the un-interrupted delivery of services during lunch and snack break. Telephone calls or personal visits to transact official business shall not be viewed as interruptions to work, meetings or trainings inside and outside the office, but rather as opportunities to serve customersOffice of the Medical Center ChiefNon-Frontline Services1. Conduction of Human Resource TrainingsNon- formal learning and Development Activities are conducted for learning purposes where participants are expected to gain or strengthen skills and technical or management expertise in their areas of endeavor.Office or Division:MCCO- Professional Education, Training and Research OfficeClassification:Simple TransactionType of Transaction:G2G-Government to GovernmentWho may avail:Training Officers, Committee ChairpersonCHECKLIST OF REQUIREMENTSWHERE TO SECURELearning Design (1 original copy)Training OfficePost Activity Report (1 original copy)Training OfficeCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit Learning Design and Details of ActivityReviews documents and recommends for approvalNone4 hoursHead, Professional Education, Training and Research OfficePETROSubmit list of participants for the approved activityRecommends for approval of division heads then MCC2.1 Approves Learning Design and Details of ActivityNone1 dayHead, Professional Education, Training and Research OfficePETROConduct activityAssists when requested*observes minimum health requirement for in-person mode activity None1 dayTraining AssistantPETROSubmit post- activity reportChecked and filedNone2 minutesTraining AssistantPETROTotal:None2 days, 4 hours and 2 minutes2. Inquiries and Other Legal AssistanceThe Legal Office extends legal assistance to employees of ITRMC with respect to their working conditions and/or working arrangements.Office or Division:MCCO- Legal OfficeClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:AllCHECKLIST OF REQUIREMENTSWHERE TO SECUREIncident Report (1 original copy)Employee seeking assistance Written Complaint (1 original copy)Employee seeking assistance Affidavits (1 original copy)Employee seeking assistanceAnnexes/Evidence (1 original copy)Employee seeking assistanceCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Employee presents documents (Incident report/written complaint/affidavits/ annexes/evidence)1. Legal staff/officer receives the documents of the client1.1 Legal staff/officer assesses the nature of the document/problem presented. None10 minutesLegal ResearcherAdministrative Assistant IILegal Office2. Employee is expected to be responsive with the questions asked by the attending officer.2. Legal staff/officer conducts an initial interview with employee. 2.1 If the problem presented is a personal one, render legal advice2.2 If the problem presented is related to the working condition/arrangment of employee, the attending officer should further assess if there is a conflict of interest (e.g suit against the hospital)2.2.1 If there is a conflict of interest, give minimal legal advice.None30 minutesAttorney IV/Legal OfficerLegal ResearcherLegal Office3. Determine possibility of a suit3. If upon assessment, a substantial ground exists as to the possibility of a suit, advice the employee to have his legal documents endorsed by his immediate supervisor to the Office of the Medical Center Chief or the grievance committee as the case may be.If the complaint is against his/her immediate supervisor, it should be endorsed by his/her division chief to the Office of the Medical Center Chief.3.1 Apprise employee that he/she should secure his/her witness(es) and other evidence to support his/her claim. None10 minutesAttorney IV/Legal OfficerLegal ResearcherAdministrative Assistant IILegal OfficeTotal:None 50 minutes3. Legal Advice [Affidavit to Use Surname of Father (AUSF)-with Legal Impediments/Issues]The Legal Office provides adequate and sufficient legal advice to clients who are in dire need of clarification or guidance with respect to paternal issues.Office or Division:MCCO- Legal OfficeClassification:Simple TransactionType of Transaction:G2C- Government to CitizenWho may avail:External ClientsCHECKLIST OF REQUIREMENTSWHERE TO SECUREAffidavit to Use Surname of Father (5 original copies)Records OfficeIdentification Card of father and mother or minor parents and guardian (1 photocopy)ApplicantCLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLE1. Client presents documents (AUSF) to the Legal Office.1. Legal staff/officer receives the AUSF of the client1.1 Legal staff/officer assesses the completeness of the documents received None1 minuteAttorney IV/Legal OfficerLegal ResearcherAdministrative Assistant IILegal Office2. Client is expected to be responsive with the questions asked by the attending officer.2. Legal staff/officer conducts an initial interview with the client2.1 After interview, the legal staff/officer renders legal advice for the client2.2 Attending officer shall put his notes/comments together with his signature and date in the document of the client before releasing it.None10 minutesAttorney IV/Legal OfficerLegal ResearcherAdministrative Assistant IILegal Office3. Client Receives Document3. The client is advised to pay the necessary fees at the cashier’s office3.1 Advice the client that after paying the required fees, he/she shall submit the AUSF to the Records Office.PHP 200.002 minutesAdministrative Assistant II/ICashier’s OfficeAdministrative Assistant II/IMedical Records OfficeTotal;P 200.0013 minutes4. Participation to External Human Resource Development ActivityAttendance to non- formal learning and development activities (LDA) organized and conducted by external providers.Office or Division:MCCO- Professional Education, Training and Research OfficeClassification:Simple TransactionType of Transaction:G2G- Government to GovernmentWho may avail:All ITRMC personnelCHECKLIST OF REQUIREMENTSWHERE TO SECUREPost Training Report (1 original copy)Training OfficeWorkplace Application Plan (1 original copy)CLIENT STEPSAGENCY ACTIONSFEES TO BE PAIDPROCESSING TIMEPERSON RESPONSIBLESubmit communication containing intent to attend external LDAReviews documents and recommend for approval and issuance of Hospital Personnel OrderNone4 hoursHead, Professional Education, Training and Research OfficePETROSubmits post training documents photocopy of certificate for trainings on official time, and WAP for official business within a week after the trainingChecks and files/ submits to Human Resource Management System (HRMS)None2 minutesTraining AssistantPETROTotalNone4 hours and 2 minutesVI. FEEDBACK AND COMPLAINTS MECHANISMFEEDBACK AND COMPLAINTS MECHANISMHow to send feedbackAccomplish Client Satisfaction Survey Form and drop it at the drop box in front of the concerned officeHow feedback are processedEvery Thursday filled CSS forms are collected from the different unitsNegative feedback is registered in the logbook and assign with a complaint numberDetails of the complaint are checked with the complainant and/or the unit/ staff concernedRFA is used to unit concerned through its assigned internal auditorUnit concerned processes RFAResults of the action taken are relayed to the complainantIf the complainant is anonymous, the details of the RFS result processing are logged in the complaint registryHow to file a complaintSubmit letter of complaint; or fill the feedback formConsults/ explains the nature of complain, if applicableAwaits the release of the action taken/ resolution for the complaintAcknowledge the receipt of the action takenHow complaints are processReceive and record formal complaint/ feedbackForward and record complaint to the Supervising Administrative OfficerForwards complaint to MCCOEvaluate the validity of complaint and recommend action, create Fact Finding CommitteeEndorse to Regional Office or dismissTake proper and appropriate action on the complaintNotify the complainant on the action takenContact Information of CCB, PCC, ARTAARTA: complaints@.phPCC:+63(2)-8736-8645Email: pcc@.phCCB: 09088816565OfficeAddressContact InformationOffice of the Medical Center Chief Parian, City of San Fernando, La UnionLocal 109; (072) 7003710Legal Services Office Integrity DevelopmentParian, City of San Fernando, La UnionLocal 111Professional Education in Training and Research OfficeParian, City of San Fernando, La UnionLocal 121Hospital Infection Control CenterParian, City of San Fernando, La UnionLocal 114Office of the Chief of Medical Professional StaffParian, City of San Fernando, La UnionLocal 169Nursing Service OfficeParian, City of San Fernando, La UnionLocal 117Finance and Management OfficeParian, City of San Fernando, La UnionLocal 207, 888Budget SectionParian, City of San Fernando, La UnionLocal 121Accounting SectionParian, City of San Fernando, La UnionLocal 125Cashier SectionParian, City of San Fernando, La UnionLocal 116Billing and Claims SectionParian, City of San Fernando, La UnionLocal 115Chief Administrative OfficeParian, City of San Fernando, La UnionLocal 127Human Resource OfficeParian, City of San Fernando, La UnionLocal 127Property and Supply Materials Management OfficeParian, City of San Fernando, La UnionLocal 134Procurement OfficeParian, City of San Fernando, La UnionLocal 133Engineering and Facilities Management OfficeParian, City of San Fernando, La UnionLocal 168 ................
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